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General NPI Number Information
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NPI Number | 1467619676
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Entity Type | Organization
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Legal Business Name | KIDS HEALTH ALLIANCE PA
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 2650 NW 2ND ST STE 100
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City | OCALA
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State | FL
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Zip | 34475-6234
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Country | US
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Telephone | 352-237-5400
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Fax | 866-260-5182
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Provider Business Mailing Address
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Address Line | 7960 SW 60TH AVE STE 100
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City | OCALA
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State | FL
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Zip | 34476-6457
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Country | US
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Telephone | 352-237-5400
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Fax | 866-260-5182
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | DR. SHAHAB EUNUS
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Credential | MD
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Telephone | 352-598-2479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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