Provider Demographics
NPI:1417422015
Name:CAPERNAUM MEDICAL CENTER FOR KIDS PLLC
Entity Type:Organization
Organization Name:CAPERNAUM MEDICAL CENTER FOR KIDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:VERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-232-4323
Mailing Address - Street 1:5129 S LAKELAND DR STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2599
Mailing Address - Country:US
Mailing Address - Phone:863-232-4323
Mailing Address - Fax:863-337-5728
Practice Address - Street 1:5129 S LAKELAND DR STE 2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2599
Practice Address - Country:US
Practice Address - Phone:863-232-4323
Practice Address - Fax:863-337-5728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPERNAUM MEDICAL CENTER FOR KIDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-10
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center