1992710503 NPI number — JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA

Table of content: (NPI 1992710503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992710503 NPI number — JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA
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:
JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA
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:
1992710503
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:
12220 BRUCE B DOWNS BLVD
Provider Second Line Business Mailing Address:
DEPT# 6500101608
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33612-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-631-5006
Provider Business Mailing Address Fax Number:
813-631-5094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12220 BRUCE B DOWNS 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:
33612-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-631-5006
Provider Business Practice Location Address Fax Number:
813-631-5094
Provider Enumeration Date:
07/30/2006

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: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH13837 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 103700500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103700501 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2009761 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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