Healthcare Provider Details

I. General information

NPI: 1235472622
Provider Name (Legal Business Name): PEDIATRICS ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 12TH ST STE 311
KEY WEST FL
33040-4088
US

IV. Provider business mailing address

1111 12TH ST STE 311
KEY WEST FL
33040-4088
US

V. Phone/Fax

Practice location:
  • Phone: 305-295-6700
  • Fax: 305-295-6600
Mailing address:
  • Phone: 305-295-6700
  • Fax: 305-295-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA JEX
Title or Position: BILLING MANAGER
Credential:
Phone: 877-817-6017