Provider Demographics
NPI:1760715767
Name:AFTER-HOURS PEDIATRIC FAMILY CARE CENTER PLC
Entity Type:Organization
Organization Name:AFTER-HOURS PEDIATRIC FAMILY CARE CENTER PLC
Other - Org Name:AFTER-HOURS PEDIATRIC FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HILEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-505-2069
Mailing Address - Street 1:PO BOX 560977
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0977
Mailing Address - Country:US
Mailing Address - Phone:321-639-2404
Mailing Address - Fax:321-636-0240
Practice Address - Street 1:234 ROSA L JONES DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7636
Practice Address - Country:US
Practice Address - Phone:321-639-2404
Practice Address - Fax:321-636-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty