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NPI Code Detail

MEDICARE: KIDS CARE PEDIATRICS,PA

MEDICARE: KIDS CARE PEDIATRICS,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
1208000000XPediatrics Physician
2261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518044528
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS CARE PEDIATRICS,PA
Provider Business Mailing Address
First Line : 6910 OLD WOLF BAY RD
Second Line :
City : PALATKA
State : FL
Zip : 32177-6800
Country : US
Telephone Number : 386-328-7337
Fax Number : 386-325-3742
Provider Business Practice Location Address
First Line : 6910 OLD WOLF BAY RD
Second Line :
City : PALATKA
State : FL
Zip : 32177-6800
Country : US
Telephone Number : 386-328-7337
Fax Number : 386-325-3742
Authorized Official
Title or Position : PRACTICE ADVISOR
Name : OWEN MARK ROSENBERG
Credential :
Telephone Number : 386-328-7337
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/15/2021

Similar Medicare Providers

1952399909 — MR. ERIC MAURICE JUMP D.O.
Practice Location Address:
6910 OLD WOLF BAY RD , KIDS CARE PEDIATRICS, PA
PALATKA, FL
32177-6800
Practice Phone: 386-328-7337
Practice Fax:
1043208093 — MRS. LAURA JEAN HOSS M.D.
Practice Location Address:
6910 OLD WOLF BAY RD , KIDS CARE PEDIATRICS, PA
PALATKA, FL
32177-6800
Practice Phone: 386-328-7337
Practice Fax:
1104814185 — KIDS CARE PEDIATRICS,PA
Practice Location Address:
6910 OLD WOLF BAY RD
PALATKA, FL
32177-6800
Practice Phone: 386-328-7337
Practice Fax:
1780672741 — MS. PAULA BERYL PHILLIPS A.R.N.P.
Practice Location Address:
6910 OLD WOLF BAY RD , KIDS CARE PEDIATRICS, PA
PALATKA, FL
32177-6800
Practice Phone: 386-328-7337
Practice Fax:
1093732919 — FLORANGEL GOMEZ EDRALIN M.D.
Practice Location Address:
6910 OLD WOLF BAY RD
PALATKA, FL
32177-6800
Practice Phone: 386-328-7337
Practice Fax: 386-325-3742
1073090205 — SYED FAHMEED IMAM MD
Practice Location Address:
6910 OLD WOLF BAY RD
PALATKA, FL
32177-6800
Practice Phone: 386-328-7337
Practice Fax:

Directions to “KIDS CARE PEDIATRICS,PA ” Practice Location

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