MEDICARE: BABIES AND BEYOND 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	208000000X	Pediatrics Physician	ME58035	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	:	1568549087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABIES AND BEYOND PEDIATRICS PA

Provider Business Mailing Address
First Line	:	224 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5691
Country	:	US
Telephone Number	:	352-686-9779
Fax Number	:	352-666-4723

Provider Business Practice Location Address
First Line	:	224 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5691
Country	:	US
Telephone Number	:	352-686-9779
Fax Number	:	352-666-4723

Authorized Official
Title or Position	:	BILLING/CREDENTIALING
Name	:	SANDY DOORNBOS
Credential	:
Telephone Number	:	727-816-9427

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	02/07/2012

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