Provider Demographics
NPI:1003946377
Name:KIDS FIRST PEDIATRICS, PA
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRICS, PA
Other - Org Name:KIDS FIRST PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-317-6000
Mailing Address - Street 1:2200 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7146
Mailing Address - Country:US
Mailing Address - Phone:972-317-6000
Mailing Address - Fax:972-317-6011
Practice Address - Street 1:2200 VILLAGE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7507
Practice Address - Country:US
Practice Address - Phone:972-317-6000
Practice Address - Fax:972-317-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083619901Medicaid