1710213525 NPI number — ALL CHILDREN'S OB/GYN SPECIALISTS

Table of content: (NPI 1710213525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710213525 NPI number — ALL CHILDREN'S OB/GYN SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL CHILDREN'S OB/GYN SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEST COAST NEONATALOGY, INC.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710213525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 946298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30394-6298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-344-6060
Provider Business Mailing Address Fax Number:
727-369-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5959 CENTRAL AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-8502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-344-6060
Provider Business Practice Location Address Fax Number:
727-347-5586
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHULHOF
Authorized Official First Name:
KRISTY
Authorized Official Middle Name:
ALICIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-898-7451

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  60-414 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 251391902 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".