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General NPI Number Information
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NPI Number | 1255492096
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Entity Type | Organization
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Legal Business Name | SEBRING PEDIATRICS., L.L.C.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 3201 MEDICAL WAY SUITE 101
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City | SEBRING
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State | FL
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Zip | 33870-5412
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Country | US
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Telephone | 863-382-0770
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Fax | 863-471-9968
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Provider Business Mailing Address
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Address Line | 3201 MEDICAL WAY SUITE 101
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City | SEBRING
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State | FL
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Zip | 33870-5412
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Country | US
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Telephone | 863-382-0770
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Fax | 863-471-9968
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Authorized Official
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Title or Position | MEDICAL DIRECTOR AND MANAGER
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Name | PRAVEEN KRISHNADAS
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Credential | M.D.
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Telephone | 863-382-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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