Provider Demographics
NPI:1679649669
Name:CHILDRENS HEALTH OF OCALA
Entity Type:Organization
Organization Name:CHILDRENS HEALTH OF OCALA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:OKONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-671-1800
Mailing Address - Street 1:1301 SE 25TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6090
Mailing Address - Country:US
Mailing Address - Phone:352-671-1800
Mailing Address - Fax:352-671-1802
Practice Address - Street 1:1301 SE 25TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6090
Practice Address - Country:US
Practice Address - Phone:352-671-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073981208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264453300Medicaid