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PEBE MED INC NPI 1568766293


NPI Information

NPI: 1568766293
Provider Name: PEBE MED, INC

Doing Business As: CHILDREN FIRST PEDIATRIC CLINIC

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 11D2020107

Address:
1267 INTERSTATE PKWY
AUGUSTA, GA
ZIP 30909
Phone: (706) 868-0919
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PEBE MED, INC is a primary care clinic center in Augusta, GA. PEBE MED, INC NPI is 1568766293. The provider is registered as an organization entity type.
The provider Is Doing Business As Children First Pediatric Clinic.

The provider's business location address is:

1267 INTERSTATE PKWY
AUGUSTA, GA
ZIP 30909-481
Phone: (706) 868-0919
Fax: (706) 868-0929

The provider's authorized official is Rosalito C Cruz .
The authorized official title is Chief Executive Officer and has the following contact phone number (706) 231-5977.

The CLIA number assigned to this NPI record is 11D2020107 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/10/2011 and was last updated on 7/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QP2300XClinic/CenterPrimary Care051131GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000940354EMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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