Provider Demographics
NPI:1255492096
Name:SEBRING PEDIATRICS., L.L.C.
Entity Type:Organization
Organization Name:SEBRING PEDIATRICS., L.L.C.
Other - Org Name:SEBRING PEDIATRICS, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNADAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-0770
Mailing Address - Street 1:3201 MEDICAL WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5412
Mailing Address - Country:US
Mailing Address - Phone:863-382-0770
Mailing Address - Fax:863-471-9968
Practice Address - Street 1:3201 MEDICAL WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5412
Practice Address - Country:US
Practice Address - Phone:863-382-0770
Practice Address - Fax:863-471-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33877OtherBLUECROSS BLUE SHIELD OF
FL377682400Medicaid
FL377682401Medicaid
FL103914Medicare Oscar/Certification