Provider Demographics
NPI:1376090357
Name:KIDS 1ST PEDIATRICS, LLC
Entity Type:Organization
Organization Name:KIDS 1ST PEDIATRICS, LLC
Other - Org Name:KIDS FIRST PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOGOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-294-1014
Mailing Address - Street 1:23800 JOHN T REID PKWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2841
Mailing Address - Country:US
Mailing Address - Phone:256-999-0808
Mailing Address - Fax:844-490-5876
Practice Address - Street 1:23800 JOHN T REID PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2841
Practice Address - Country:US
Practice Address - Phone:256-999-0808
Practice Address - Fax:256-999-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL194294Medicaid