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General NPI Number Information
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NPI Number | 1770853665
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Entity Type | Organization
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Legal Business Name | RIVERVIEW KIDCARE
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 10420 US HIGHWAY 301 S
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City | RIVERVIEW
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State | FL
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Zip | 33578-5806
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Country | US
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Telephone | 813-677-7989
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Fax |
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Provider Business Mailing Address
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Address Line | 10420 US HIGHWAY 301 S
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City | RIVERVIEW
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State | FL
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Zip | 33578-5806
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Country | US
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Telephone | 813-677-7989
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | PATRICIA HOEPNER
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Credential | MD
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Telephone | 813-677-7989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 71781
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License Number State | FL
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