1417157538 NPI number — CHILDREN'S SPECIALISTS OF FL PA

Table of content: DR. SAMANTHA CLARE SYMONS MD (NPI 1669505566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417157538 NPI number — CHILDREN'S SPECIALISTS OF FL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S SPECIALISTS OF FL PA
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:
Provider Other Organization Name Type Code:
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:
1417157538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7970 SUMMERLIN LAKES DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-1855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-437-5500
Provider Business Mailing Address Fax Number:
239-437-5507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7970 SUMMERLIN LAKES DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-437-5500
Provider Business Practice Location Address Fax Number:
239-437-5507
Provider Enumeration Date:
07/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARTOW
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
COFFER
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
239-437-5500

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0069766 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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