Provider Demographics
NPI:1497421267
Name:WILLISTON PEDIATRICS, INC
Entity type:Organization
Organization Name:WILLISTON PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-529-0477
Mailing Address - Street 1:223 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2136
Mailing Address - Country:US
Mailing Address - Phone:352-529-0477
Mailing Address - Fax:352-529-0406
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2136
Practice Address - Country:US
Practice Address - Phone:352-529-0477
Practice Address - Fax:352-529-0406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLISTON PEDIATRICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health