Provider Demographics
NPI:1669469771
Name:HOMESTEAD PEDIATRIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HOMESTEAD PEDIATRIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-245-4549
Mailing Address - Street 1:975 BAPTIST WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7600
Mailing Address - Country:US
Mailing Address - Phone:305-245-4549
Mailing Address - Fax:305-245-4590
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:305-245-4549
Practice Address - Fax:305-245-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29246OtherBLUECROSSBLUESHIELD
FL194198OtherAMERIGROUP
FL178147OtherJMH
FL272565700Medicaid
FL11071OtherDIMENSION
FL297302OtherAVMED
FLSG078319/H922OtherVISTA
FL4554532OtherCIGNA
FL52761-83861OtherNHP
FL5666752OtherFIRSTHEALTH
FL272565700Medicaid
FL=========OtherTRICARE
FL=========OtherHUMANA
FL297302OtherAVMED
FL4554532OtherCIGNA
FL=========OtherAETNA