Provider Demographics
NPI:1710080924
Name:ALL CHILDREN'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:ALL CHILDREN'S HOSPITAL, INC.
Other - Org Name:ALL CHILDREN'S OUTPATIENT CARE, TAMPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:SCHULHOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-898-7451
Mailing Address - Street 1:501 6TH AVE. S.
Mailing Address - Street 2:DEPT. 7300
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-767-8670
Mailing Address - Fax:727-767-8441
Practice Address - Street 1:12220 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-631-5006
Practice Address - Fax:813-631-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH00138373336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1037005001OtherMEDICAID DME
1077470OtherNABP
FL103700500Medicaid