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General NPI Number Information
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NPI Number | 1679017339
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Entity Type | Organization
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Legal Business Name | MIMS SITTER SERVICE, INC
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 2129 UPTON CT S
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City | ST PETERSBURG
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State | FL
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Zip | 33712-3145
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Country | US
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Telephone | 727-322-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 2129 UPTON CT S
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City | ST PETERSBURG
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State | FL
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Zip | 33712-3145
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Country | US
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Telephone | 727-322-3644
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | MISS MARY LOUISE MIMS I
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Credential |
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Telephone | 727-322-3644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | N16000011186
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License Number State | FL
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