1649983628 NPI number — EVENING PEDIATRICS INC

Table of content: DR. ANGELA AMUDHA XAVIER M.D. (NPI 1558320432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649983628 NPI number — EVENING PEDIATRICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVENING PEDIATRICS 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:
YOUR KIDS URGENT CARE
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:
1649983628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 CENTRAL AVE
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:
33713-8815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-526-9135
Provider Business Mailing Address Fax Number:
727-526-4346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8318 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD RANCH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34202-5137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-855-6483
Provider Business Practice Location Address Fax Number:
941-444-5507
Provider Enumeration Date:
01/04/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHAIL
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
727-526-9135

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 277728208 . 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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