Provider Demographics
NPI:1497179147
Name:1ST CHOICE PEDIATRICS
Entity Type:Organization
Organization Name:1ST CHOICE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRORY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-230-0235
Mailing Address - Street 1:1205 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5539
Mailing Address - Country:US
Mailing Address - Phone:903-230-0235
Mailing Address - Fax:903-230-0242
Practice Address - Street 1:1205 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5539
Practice Address - Country:US
Practice Address - Phone:903-230-0235
Practice Address - Fax:903-230-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1292369-04Medicaid
TXG72460Medicare UPIN