Provider Demographics
NPI:1417157538
Name:CHILDREN'S SPECIALISTS OF FL PA
Entity Type:Organization
Organization Name:CHILDREN'S SPECIALISTS OF FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:COFFER
Authorized Official - Last Name:BARTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-437-5500
Mailing Address - Street 1:7970 SUMMERLIN LAKES DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1855
Mailing Address - Country:US
Mailing Address - Phone:239-437-5500
Mailing Address - Fax:239-437-5507
Practice Address - Street 1:7970 SUMMERLIN LAKES DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1855
Practice Address - Country:US
Practice Address - Phone:239-437-5500
Practice Address - Fax:239-437-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty