Provider Demographics
NPI:1972806610
Name:KIDS FIRST PEDIATRIC CENTER
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILIZ
Authorized Official - Middle Name:BORBON
Authorized Official - Last Name:BUMGARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-431-6413
Mailing Address - Street 1:3447 PINE RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3927
Mailing Address - Country:US
Mailing Address - Phone:239-431-6413
Mailing Address - Fax:239-431-6417
Practice Address - Street 1:3447 PINE RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3927
Practice Address - Country:US
Practice Address - Phone:239-431-6413
Practice Address - Fax:239-431-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-91688208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271218100Medicaid
FL52180AMedicare PIN
FL271218100Medicaid