Provider Demographics
NPI:1467619676
Name:KIDS HEALTH ALLIANCE PA
Entity Type:Organization
Organization Name:KIDS HEALTH ALLIANCE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:EUNUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-598-2479
Mailing Address - Street 1:7960 SW 60TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6457
Mailing Address - Country:US
Mailing Address - Phone:352-237-5400
Mailing Address - Fax:866-260-5182
Practice Address - Street 1:2650 NW 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-6234
Practice Address - Country:US
Practice Address - Phone:352-237-5400
Practice Address - Fax:866-260-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023548300Medicaid
FL023548301Medicaid
103933OtherPTAN