Provider Demographics
NPI:1568549087
Name:BABIES AND BEYOND PEDIATRICS PA
Entity Type:Organization
Organization Name:BABIES AND BEYOND PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOORNBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-816-9427
Mailing Address - Street 1:224 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5691
Mailing Address - Country:US
Mailing Address - Phone:352-686-9779
Mailing Address - Fax:352-666-4723
Practice Address - Street 1:224 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5691
Practice Address - Country:US
Practice Address - Phone:352-686-9779
Practice Address - Fax:352-666-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054354301Medicaid