Provider Demographics
NPI:1912189085
Name:PEDIATRICS TO PARENTS MEDICAL, PC
Entity Type:Organization
Organization Name:PEDIATRICS TO PARENTS MEDICAL, PC
Other - Org Name:PEDS TO PARENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JC
Authorized Official - Last Name:FEJERAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-626-1931
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37824-0959
Mailing Address - Country:US
Mailing Address - Phone:423-626-1931
Mailing Address - Fax:423-626-1948
Practice Address - Street 1:1442 N BROAD ST
Practice Address - Street 2:SUITE 7
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4361
Practice Address - Country:US
Practice Address - Phone:423-626-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000999261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3303563Medicaid
F76545Medicare UPIN
TN3303563Medicaid