| Peds To Parents | |
|
1442 N Broad St Suite 7 Tazewell TN 37879-4361 | |
| (423) 626-1931 | |
| Not Available |
| Full Name | Peds To Parents |
|---|---|
| Speciality | Clinic/Center |
| Location | 1442 N Broad St, Tazewell, Tennessee |
| Authorized Official Name and Position | Ronald Jc Fejeran (PRESIDENT AND PHYSICIAN) |
| Authorized Official Contact | 4236261931 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peds To Parents Po Box 959 New Tazewell TN 37824-0959 Ph: (423) 626-1931 | Peds To Parents 1442 N Broad St Suite 7 Tazewell TN 37879-4361 Ph: (423) 626-1931 |
| NPI Number | 1912189085 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 08/12/2008 |
| Medicare PECOS PAC ID | 0446324255 |
|---|---|
| Medicare Enrollment ID | O20081118000798 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912189085 | NPI | - | NPPES |
| 3303563 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 000999 (Tennessee) | Primary |
| Provider Name | Ronald J Fejeran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073518288 PECOS PAC ID: 2466345871 Enrollment ID: I20081107000512 |
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