Provider Demographics
NPI:1356532204
Name:KIDS FIRST PEDIATRICS PA
Entity type:Organization
Organization Name:KIDS FIRST PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-533-1123
Mailing Address - Street 1:2000 OSPREY BLVD
Mailing Address - Street 2:107
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830
Mailing Address - Country:US
Mailing Address - Phone:863-533-1123
Mailing Address - Fax:863-519-9808
Practice Address - Street 1:2000 OSPREY BLVD S
Practice Address - Street 2:107
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830
Practice Address - Country:US
Practice Address - Phone:863-533-1123
Practice Address - Fax:863-519-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83372208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF76928Medicare UPIN