COMMUNITY CARE PEDIATRICS PA NPI 1639437569

NPI Information

NPI: 1639437569
Provider Name: COMMUNITY CARE PEDIATRICS PA
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 10D2035543

Address:
3670 US 1 SOUTH STE 300 B
SAINT AUGUSTINE, FL
ZIP 32086
Phone: (904) 479-9501
Get Directions

COMMUNITY CARE PEDIATRICS PA is a primary care clinic center in Saint Augustine, FL. COMMUNITY CARE PEDIATRICS PA NPI is 1639437569. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3670 US 1 SOUTH STE 300 B
SAINT AUGUSTINE, FL
ZIP 32086
Phone: (904) 479-9501
Fax: (904) 217-0524

The provider's authorized official is Luis Anderson .
The authorized official title is Md/president/owner and has the following contact phone number (904) 479-9501.

The CLIA number assigned to this NPI record is 10D2035543 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/28/2012 and was last updated on 2/14/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics				No
2	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	269304600	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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