MEDICARE: EVENING PEDIATRICS INC

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
1	261QU0200X	Urgent Care Clinic/Center
2	261Q00000X	Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1780311241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVENING PEDIATRICS INC

Provider Business Mailing Address
First Line	:	2115 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8815
Country	:	US
Telephone Number	:	727-526-9135
Fax Number	:

Provider Business Practice Location Address
First Line	:	3607 ALOMA AVE STE 1091
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-8856
Country	:	US
Telephone Number	:	321-340-5919
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KELLY MCPHAIL
Credential	:
Telephone Number	:	727-526-9135

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	02/27/2024

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Directions to “EVENING PEDIATRICS INC ” Practice Location

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