Provider Demographics
NPI:1922286426
Name:SMALL WORLD PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:SMALL WORLD PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JIMENEZ MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-907-8001
Mailing Address - Street 1:PO BOX 47957
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646
Mailing Address - Country:US
Mailing Address - Phone:813-907-8001
Mailing Address - Fax:813-907-5744
Practice Address - Street 1:2527 WINDGUARD CIR
Practice Address - Street 2:STE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7347
Practice Address - Country:US
Practice Address - Phone:813-907-8001
Practice Address - Fax:813-907-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79938208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258877300Medicaid
FL259225800Medicaid