Healthcare Provider Details

I. General information

NPI: 1558411520
Provider Name (Legal Business Name): KIDSFIRST PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 MONARCH PT
GREENEVILLE TN
37745-4275
US

IV. Provider business mailing address

5000 MONARCH PT
GREENEVILLE TN
37745-4275
US

V. Phone/Fax

Practice location:
  • Phone: 423-798-6630
  • Fax: 423-798-6633
Mailing address:
  • Phone: 423-798-6630
  • Fax: 423-798-6633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO0000001255
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000007290
License Number StateTN

VIII. Authorized Official

Name: DR. RICHARD S MCGILL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 423-798-6630