Provider Demographics
NPI:1831201276
Name:PEDIATRIC ASSOCIATES OF KINGSTON, LLC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF KINGSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JR
Authorized Official - Middle Name:
Authorized Official - Last Name:VOUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-288-6543
Mailing Address - Street 1:451 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5802
Mailing Address - Country:US
Mailing Address - Phone:570-288-6543
Mailing Address - Fax:570-288-7130
Practice Address - Street 1:451 3RD AVE STE 1
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5802
Practice Address - Country:US
Practice Address - Phone:570-288-6543
Practice Address - Fax:570-288-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty