Provider Demographics
NPI:1770853665
Name:RIVERVIEW KIDCARE
Entity Type:Organization
Organization Name:RIVERVIEW KIDCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-677-7989
Mailing Address - Street 1:10420 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5806
Mailing Address - Country:US
Mailing Address - Phone:813-677-7989
Mailing Address - Fax:
Practice Address - Street 1:10420 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5806
Practice Address - Country:US
Practice Address - Phone:813-677-7989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL717812080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty