Provider Demographics
NPI:1619378601
Name:JUST 4 KIDS PEDIATRICS
Entity Type:Organization
Organization Name:JUST 4 KIDS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:S
Authorized Official - Last Name:METHVIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:931-363-0077
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0910
Mailing Address - Country:US
Mailing Address - Phone:931-363-0077
Mailing Address - Fax:
Practice Address - Street 1:910 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3630
Practice Address - Country:US
Practice Address - Phone:931-363-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty