Provider Demographics
NPI:1376609891
Name:PLANT CITY PEDIATRICS, PA
Entity Type:Organization
Organization Name:PLANT CITY PEDIATRICS, PA
Other - Org Name:TIMOTHY WILLIAMS PEDIATRICS OF BRANDON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-659-9800
Mailing Address - Street 1:2370 WALDEN WOODS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7027
Mailing Address - Country:US
Mailing Address - Phone:813-659-9800
Mailing Address - Fax:813-659-9807
Practice Address - Street 1:2370 WALDEN WOODS DR
Practice Address - Street 2:SUITE A
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7027
Practice Address - Country:US
Practice Address - Phone:813-659-9800
Practice Address - Fax:813-659-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7802208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1154340115OtherNPI
FL1215909262OtherNPI
FL1851713952Medicaid
FL1609809987OtherNPI
FL1649248956OtherPLANT CITY PEDIATRICS
FL1376609891Medicaid
FL1821065061Medicaid
FL1275706160Medicaid