Provider Demographics
NPI:1235439613
Name:KIDS FIRST PEDIATRICS OF RAEFORD, PC
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRICS OF RAEFORD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAMOR
Authorized Official - Middle Name:DE LEON
Authorized Official - Last Name:BUENASEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-848-5437
Mailing Address - Street 1:4005 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8058
Mailing Address - Country:US
Mailing Address - Phone:910-848-5437
Mailing Address - Fax:910-848-5439
Practice Address - Street 1:4005 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8058
Practice Address - Country:US
Practice Address - Phone:910-848-5437
Practice Address - Fax:910-848-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922034Medicaid