Provider Demographics
NPI:1386682284
Name:FIRST STEPS PEDIATRICS & ADOLESCENT MEDICINE PLLC
Entity Type:Organization
Organization Name:FIRST STEPS PEDIATRICS & ADOLESCENT MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OFFICE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-723-4000
Mailing Address - Street 1:PO BOX 2304
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1504
Mailing Address - Country:US
Mailing Address - Phone:304-723-4000
Mailing Address - Fax:304-794-7100
Practice Address - Street 1:3045 PENNSYLVANIA AVE
Practice Address - Street 2:LEVEL 1 SUITE 3
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3770
Practice Address - Country:US
Practice Address - Phone:304-723-4000
Practice Address - Fax:304-794-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2282533Medicaid
WV0202709000Medicaid