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NPI Code Detail

MEDICARE: ORANGE PARK PEDIATRIC ASSOCIATES, PA

MEDICARE: ORANGE PARK PEDIATRIC ASSOCIATES, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080A0000XPediatric Adolescent Medicine Physician

General Provider Information

NPI Number : 1205878725
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORANGE PARK PEDIATRIC ASSOCIATES, PA
Provider Business Mailing Address
First Line : 2140 SMITH ST
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-5554
Country : US
Telephone Number : 904-269-2145
Fax Number : 904-278-5038
Provider Business Practice Location Address
First Line : 2140 SMITH ST
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-5554
Country : US
Telephone Number : 904-269-2145
Fax Number : 904-278-5038
Authorized Official
Title or Position : SUPERVISOR
Name : MS. MAGGIE MACY
Credential :
Telephone Number : 904-269-2145
Provider Enumeration Date : 06/11/2006
Last Update Date : 12/11/2008

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Directions to “ORANGE PARK PEDIATRIC ASSOCIATES, PA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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