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SOUTH LAKE PEDIATRICS P.A. NPI 1699076901


NPI Information

NPI: 1699076901
Provider Name: SOUTH LAKE PEDIATRICS, P.A.
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 10D0868886

Address:
3155 CITRUS TOWER BLVD
BLDG.# 1
CLERMONT, FL
ZIP 34711
Phone: (352) 242-1500
Get Directions

SOUTH LAKE PEDIATRICS, P.A. is a pediatrics in Clermont, FL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SOUTH LAKE PEDIATRICS, P.A. NPI is 1699076901. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3155 CITRUS TOWER BLVD
BLDG.# 1
CLERMONT, FL
ZIP 34711-803
Phone: (352) 242-1500
Fax: (352) 242-0053

The provider's authorized official is Adinarayanamurthy Nallamshetty .
The authorized official title is President and has the following contact phone number (352) 242-1500.

The CLIA number assigned to this NPI record is 10D0868886 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/3/2010 and was last updated on 11/3/2010.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsME073750FLORIDAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1260240700MEDICAIDFLORIDA

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: 11/14/2023

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