1386682284 NPI number — FIRST STEPS PEDIATRICS & ADOLESCENT MEDICINE PLLC

Table of content: (NPI 1386682284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386682284 NPI number — FIRST STEPS PEDIATRICS & ADOLESCENT MEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STEPS PEDIATRICS & ADOLESCENT MEDICINE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386682284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEIRTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26062-1504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-723-4000
Provider Business Mailing Address Fax Number:
304-794-7100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3045 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
LEVEL 1 SUITE 3
Provider Business Practice Location Address City Name:
WEIRTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26062-3770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-723-4000
Provider Business Practice Location Address Fax Number:
304-794-7100
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LITTLE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MANAGER OF OFFICE OPERATIONS
Authorized Official Telephone Number:
304-723-4000

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2282533 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0202709000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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