MEDICARE: CSI-PEDIATRIC SERVICES, LLC.

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	261QH0100X	Health Service Clinic/Center	60081003	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	:	1407277171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSI-PEDIATRIC SERVICES, LLC.

Provider Business Mailing Address
First Line	:	15050 NW 79TH CT STE 201
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5810
Country	:	US
Telephone Number	:	786-522-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	10750 ATLANTIC BLVD
Second Line	:	SUITE 11
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2946
Country	:	US
Telephone Number	:	904-380-0419
Fax Number	:	904-564-3716

Authorized Official
Title or Position	:	CEO
Name	:	DONNA LODATO
Credential	:	RN
Telephone Number	:	786-522-9600

Provider Enumeration Date	:	12/26/2013
Last Update Date	:	07/13/2022

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