Provider Demographics
NPI:1497007553
Name:LITTLE PINE PEDIATRICS PLLC
Entity Type:Organization
Organization Name:LITTLE PINE PEDIATRICS PLLC
Other - Org Name:LITTLE PINE PEDIATRICS OF MADISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:855-577-5437
Mailing Address - Street 1:1702 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-5611
Mailing Address - Country:US
Mailing Address - Phone:855-577-5437
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE PINE PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-12
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10208261QP2300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001165802Medicaid