SOUTH BOSTON PEDIATRICS, PC
NPI 1356690366
Pediatrics in South Boston, VA

Q: What is South Boston Pediatrics, PC's NPI number?

The NPI number for South Boston Pediatrics, PC is 1356690366. It was assigned to this organization in the NPPES registry on September 5, 2012.

Q: What is South Boston Pediatrics, PC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since September 05, 2012CLIA 49D2053393 · Waiver

2202 BEECHMONT RD, SOUTH BOSTON, VA 24592(434) 572-3635 Get Directions Write a Review

NPPES record last updated: September 5, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About South Boston Pediatrics, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH BOSTON PEDIATRICS, PC (NPI 1356690366) is a healthcare organization registered as a pediatrics in South Boston, Virginia and active in the NPI registry since September 2012. The organization holds a CLIA Waiver certificate valid through January 29, 2027 and lists Nonna Lyn Ebalo, President, as its authorized official.

NPPES Registry Identity

NPI1356690366

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameSOUTH BOSTON PEDIATRICS, PC

Location Address2202 BEECHMONT RDSouth Boston, VA 24592-1614

Mailing AddressPo Box 774South Boston, VA 24592-0774 · (434) 572-3635

Phone(434) 572-3635

Organization SubpartNo

Authorized OfficialNonna Lyn EbaloPresident · (434) 470-3489

Enumeration DateSeptember 5, 2012

✔ NPI 1356690366 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in VA · 0101232220

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

2202 BEECHMONT RD, South Boston, VA 24592

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Other Identifiers 2

Medicaid01046086VA

Medicare UPINH33153VA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2053393

South Boston Pediatrics · South Boston, VA

Active · expires Jan 29, 2027

CLIA Number49D2053393

Laboratory TypePhysician Office

Certificate Effective DateJanuary 30, 2025

Certificate Expiration DateJanuary 29, 2027

Laboratory DirectorNonna L. Ebalo

Laboratory Phone(434) 572-3635

Laboratory LocationSouth Boston Pediatrics2202 Beechmont Road, South Boston, VA 24592

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COMMUNITY PHCY OF SOUTH BOSTON,INC

Pharmacy (Community/Retail Pharmacy)

2202 BEECHMONT RD
SOUTH BOSTON, VA 24592

Halifax County (434) 575-7988

NONNA LYN M EBALO MD

Pediatrics

2202 BEECHMONT RD
SOUTH BOSTON, VA 24592

Halifax County (434) 572-3635

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Boston Pediatrics, PC's NPI number?

The NPI number for South Boston Pediatrics, PC is 1356690366. It was assigned to this organization in the NPPES registry on September 5, 2012.

Where is South Boston Pediatrics, PC located?

South Boston Pediatrics, PC is located at 2202 Beechmont Rd, South Boston, VA 24592. The listed phone number is (434) 572-3635.

What is South Boston Pediatrics, PC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does South Boston Pediatrics, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2053393) is associated with this NPI, valid through January 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for South Boston Pediatrics, PC was last updated on September 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.