Provider Demographics
NPI:1962619502
Name:WESTBURY PEDIATRICS LTD.
Entity type:Organization
Organization Name:WESTBURY PEDIATRICS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-978-1772
Mailing Address - Street 1:2954 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7861
Mailing Address - Country:US
Mailing Address - Phone:636-978-1772
Mailing Address - Fax:636-978-2589
Practice Address - Street 1:2954 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7861
Practice Address - Country:US
Practice Address - Phone:636-978-1772
Practice Address - Fax:636-978-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1052262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty