MEDICARE: MILESTONE PEDIATRICS DBA CHILDREN FIRST PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1861500845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONE PEDIATRICS DBA CHILDREN FIRST PEDIATRICS

Provider Business Mailing Address
First Line	:	8627 CINNAMON CREEK DR
Second Line	:	BLDG 1
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1480
Country	:	US
Telephone Number	:	210-641-5437
Fax Number	:	210-641-6420

Provider Business Practice Location Address
First Line	:	8627 CINNAMON CREEK DR
Second Line	:	BLDG 1
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1480
Country	:	US
Telephone Number	:	210-641-5437
Fax Number	:	210-641-6420

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. PENNY FISHER
Credential	:
Telephone Number	:	210-641-5437

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	06/11/2008

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