=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619662624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMIKIDS FAMILY SERVICES' INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2023
-----------------------------------------------------
Last Update Date | 06/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6208 MONTGOMERY BLVD NE STE C
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-220-1258
-----------------------------------------------------
Fax | 505-220-0820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5915 BENJAMIN CENTER DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33634-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-887-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING & CREDENTIALING MANAGER
-----------------------------------------------------
Name | DIANNA BARBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-734-5678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------