1376609891 NPI number — PLANT CITY PEDIATRICS, PA

Table of content: (NPI 1376609891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376609891 NPI number — PLANT CITY PEDIATRICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANT CITY PEDIATRICS, 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:
6
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:
1376609891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2370 WALDEN WOODS DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PLANT CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33563-7027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-659-9800
Provider Business Mailing Address Fax Number:
813-659-9807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2370 WALDEN WOODS DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PLANT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33563-7027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-659-9800
Provider Business Practice Location Address Fax Number:
813-659-9807
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIFER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
813-659-9800

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  OS7802 , 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)

  • Identifier: 1154340115 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1215909262 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1851713952 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609809987 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1649248956 . This is a "PLANT CITY PEDIATRICS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1376609891 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821065061 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275706160 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275767200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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