Provider Demographics
NPI:1003016858
Name:WE CARE PEDIATRIC CC, PA
Entity Type:Organization
Organization Name:WE CARE PEDIATRIC CC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KOSOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-236-9310
Mailing Address - Street 1:PO BOX 1885
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33568-1885
Mailing Address - Country:US
Mailing Address - Phone:813-236-9310
Mailing Address - Fax:813-236-9311
Practice Address - Street 1:9406 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5116
Practice Address - Country:US
Practice Address - Phone:813-236-9310
Practice Address - Fax:813-236-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79005261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME79005OtherMEDICAL LICENSE
FLME79005OtherMEDICAL LICENSE