Provider Demographics
NPI:1104838796
Name:KIDSFIRST PEDIATRICS COMPANY
Entity Type:Organization
Organization Name:KIDSFIRST PEDIATRICS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-918-0501
Mailing Address - Street 1:35010 CHARDON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9010
Mailing Address - Country:US
Mailing Address - Phone:440-918-0501
Mailing Address - Fax:440-918-0525
Practice Address - Street 1:35010 CHARDON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9010
Practice Address - Country:US
Practice Address - Phone:440-918-0501
Practice Address - Fax:440-918-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2573826Medicaid