Provider Demographics
NPI:1811447824
Name:LITTLE PINE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:LITTLE PINE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:855-577-5437
Mailing Address - Street 1:1702 S. JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348
Mailing Address - Country:US
Mailing Address - Phone:855-577-5437
Mailing Address - Fax:850-838-2140
Practice Address - Street 1:1702 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-5611
Practice Address - Country:US
Practice Address - Phone:855-577-5437
Practice Address - Fax:850-838-2140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE PINE PEDIATRICS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001165801Medicaid