MEDICARE: LONGLEAF PEDIATRICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	255837800	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114310851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONGLEAF PEDIATRICS PA

Provider Business Mailing Address
First Line	:	PO BOX 740715
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32774-0715
Country	:	US
Telephone Number	:	386-532-0800
Fax Number	:	386-532-7005

Provider Business Practice Location Address
First Line	:	103 BIRCH AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7003
Country	:	US
Telephone Number	:	386-532-0800
Fax Number	:	386-532-7005

Authorized Official
Title or Position	:	PEDIATRICIAN/OWNER
Name	:	DR. VALERIE CELESTE BURNS
Credential	:	M.D.
Telephone Number	:	386-532-0800

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/05/2015

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Directions to “LONGLEAF PEDIATRICS PA ” Practice Location

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