| Name: | KIDS 1ST PEDIATRICS, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 19 Jul 2016 (8 years ago) |
| Entity Number: | 000-367-538 |
| Register Number: | 000367538 |
| Place of Formation: | DeKalb County |
| Registered Office Street Address: | 1359 OLD WATER WORKS RD SWFORT PAYNE, AL 35968-3347 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376090357 | 2016-09-07 | 2023-08-08 | 23800 JOHN T REID PKWY, SCOTTSBORO, AL, 357682841, US | 23800 JOHN T REID PKWY, SCOTTSBORO, AL, 357682841, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 256-999-0808 |
| Fax | 8444905876 |
| Fax | 2569990809 |
Authorized person
| Name | DR. PETER STOGOV |
| Role | OWNER/PRESIDENT |
| Phone | 9082941014 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 194294 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| STROGOV, PETER | Organizer | 1359 OLD WATERWORKS ROAD SOUTHWESTFORT PAYNE, AL 35968 |
| Name | Role | Address |
|---|---|---|
| STROGOV, PETER | Agent | 1359 OLD WATERWORKS ROAD SOUTHWESTFORT PAYNE, AL 35968 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
