Provider Demographics
NPI:1043761539
Name:LITTLE PINE PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:LITTLE PINE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-253-2275
Mailing Address - Street 1:194 NE HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-2546
Mailing Address - Country:US
Mailing Address - Phone:850-253-2275
Mailing Address - Fax:850-253-2280
Practice Address - Street 1:194 NE HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2546
Practice Address - Country:US
Practice Address - Phone:850-253-2275
Practice Address - Fax:850-253-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001165802Medicaid