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General NPI Number Information
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NPI Number | 1003016858
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Entity Type | Organization
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Legal Business Name | WE CARE PEDIATRIC CC, PA
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 9406 BALM RIVERVIEW RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5116
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Country | US
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Telephone | 813-236-9310
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Fax | 813-236-9311
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Provider Business Mailing Address
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Address Line | PO BOX 1885
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City | RIVERVIEW
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State | FL
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Zip | 33568-1885
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Country | US
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Telephone | 813-236-9310
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Fax | 813-236-9311
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER ALLEN KOSOFF
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Credential | MD
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Telephone | 813-236-9310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME79005
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License Number State | FL
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