=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497196000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEP NETWORK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2013
-----------------------------------------------------
Last Update Date | 07/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5150 PALM VALLEY RD SUITE 200
-----------------------------------------------------
City | PONTE VEDRA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32082-4629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-834-2260
-----------------------------------------------------
Fax | 904-834-3968
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5150 PALM VALLEY RD SUITE 200
-----------------------------------------------------
City | PONTE VEDRA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32082-4629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-834-2260
-----------------------------------------------------
Fax | 904-834-3968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PRINCIPAL
-----------------------------------------------------
Name | MR. JON CHARLES KAEUPER
-----------------------------------------------------
Credential | BS
-----------------------------------------------------
Telephone | 904-834-2260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------