Provider Demographics
NPI:1235472622
Name:PEDIATRICS ALLIANCE LLC
Entity Type:Organization
Organization Name:PEDIATRICS ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-817-6017
Mailing Address - Street 1:1111 12TH ST
Mailing Address - Street 2:STE 311
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4088
Mailing Address - Country:US
Mailing Address - Phone:305-295-6700
Mailing Address - Fax:305-295-6600
Practice Address - Street 1:1111 12TH ST
Practice Address - Street 2:STE 311
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4088
Practice Address - Country:US
Practice Address - Phone:305-295-6700
Practice Address - Fax:305-295-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty