Provider Demographics
NPI:1790973394
Name:NIGHT OWL PEDIATRICS PA
Entity Type:Organization
Organization Name:NIGHT OWL PEDIATRICS PA
Other - Org Name:NIGHT OWL FAMILY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ADS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-306-2518
Mailing Address - Street 1:10359 CROSS CREEK BLVD STE CD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2772
Mailing Address - Country:US
Mailing Address - Phone:813-994-0044
Mailing Address - Fax:813-994-0055
Practice Address - Street 1:10359 CROSS CREEK BLVD
Practice Address - Street 2:SUITE CD
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2772
Practice Address - Country:US
Practice Address - Phone:813-994-0044
Practice Address - Fax:813-994-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65878174400000X
2080P0204X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000714800Medicaid
FL375833800Medicaid
FLB905POtherBCBSFL
FLBL081YOtherBCBSFL