Provider Demographics
NPI:1245068071
Name:FIRST PLACE PEDIATRICS, LLC
Entity type:Organization
Organization Name:FIRST PLACE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MANICCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-914-2267
Mailing Address - Street 1:9011 MOUNTAIN RIDGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9011 MOUNTAIN RIDGE DR STE 130
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7394
Practice Address - Country:US
Practice Address - Phone:512-914-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FPPS-CALIFORNIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health