1770532798 NPI number — PEDIATRIC PHYSICIAN SERVICES, INC.

Table of content: (NPI 1770532798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770532798 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:
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:
1770532798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2022
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
Provider Second Line Business Mailing Address:
5TH FLOOR DEPT 6941
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701
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:
601 5TH ST S
Provider Second Line Business Practice Location Address:
DEPARTMENT 6941
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-767-4429
Provider Business Practice Location Address Fax Number:
727-767-4970
Provider Enumeration Date:
05/08/2006

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: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0207X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0120X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 21399 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 252285316 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00222 . This is a "BLUE SHIELD OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 252285300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285306 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285317 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285318 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285319 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285301 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285321 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285307 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285308 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285309 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285303 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252285311 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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