Provider Demographics
NPI:1730248220
Name:YORK PEDIATRICS
Entity type:Organization
Organization Name:YORK PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOKS
Authorized Official - Middle Name:O
Authorized Official - Last Name:AYODELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-980-6610
Mailing Address - Street 1:1538 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3857
Mailing Address - Country:US
Mailing Address - Phone:803-980-6610
Mailing Address - Fax:803-980-6162
Practice Address - Street 1:1538 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3857
Practice Address - Country:US
Practice Address - Phone:803-980-6610
Practice Address - Fax:803-980-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2934Medicaid