Provider Demographics
NPI:1487654042
Name:KG HEALTH PARTNERS, INC
Entity Type:Organization
Organization Name:KG HEALTH PARTNERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-565-1495
Mailing Address - Street 1:6021 142ND AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2822
Mailing Address - Country:US
Mailing Address - Phone:727-796-6900
Mailing Address - Fax:727-669-8417
Practice Address - Street 1:6021 142ND AVE N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-2822
Practice Address - Country:US
Practice Address - Phone:727-796-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10003213E00000X
213EP1101X, 213EP1101X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020801000Medicaid
CI8898OtherRAILROAD MEDICARE
FL38362OtherBCBS
FLK0581Medicare PIN
FL38362OtherBCBS