Provider Demographics
NPI:1861500845
Name:MILESTONE PEDIATRICS DBA CHILDREN FIRST PEDIATRICS
Entity Type:Organization
Organization Name:MILESTONE PEDIATRICS DBA CHILDREN FIRST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-641-5437
Mailing Address - Street 1:8627 CINNAMON CREEK DR
Mailing Address - Street 2:BLDG 1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1480
Mailing Address - Country:US
Mailing Address - Phone:210-641-5437
Mailing Address - Fax:210-641-6420
Practice Address - Street 1:8627 CINNAMON CREEK DR
Practice Address - Street 2:BLDG 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1480
Practice Address - Country:US
Practice Address - Phone:210-641-5437
Practice Address - Fax:210-641-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG35485Medicare UPIN
TXE77655Medicare UPIN
TXC78014Medicare UPIN
TXG21515Medicare UPIN