Healthcare Provider Details

I. General information

NPI: 1497179147
Provider Name (Legal Business Name): 1ST CHOICE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N 6TH ST
LONGVIEW TX
75601-5539
US

IV. Provider business mailing address

1205 N 6TH ST
LONGVIEW TX
75601-5539
US

V. Phone/Fax

Practice location:
  • Phone: 903-230-0235
  • Fax: 903-230-0242
Mailing address:
  • Phone: 903-230-0235
  • Fax: 903-230-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK1253
License Number StateTX

VIII. Authorized Official

Name: DR. KATHLEEN MCCRORY
Title or Position: CEO
Credential: DO
Phone: 903-230-0235