1386393387 NPI number — PEDIATRIC PHYSICIAN SERVICES, INC.

Table of content: (NPI 1386393387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386393387 NPI number — PEDIATRIC PHYSICIAN SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC PHYSICIAN SERVICES, INC.
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:
ALL CHILDREN'S SPECIALTY PHYSICIANS
Provider Other Organization Name Type Code:
3
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:
1386393387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 5TH ST S DEPT 6941
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-767-4429
Provider Business Mailing Address Fax Number:
727-767-4970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3440 W MLK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-6223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-910-5140
Provider Business Practice Location Address Fax Number:
813-350-0132
Provider Enumeration Date:
03/18/2022

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: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2278P3900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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