Provider Demographics
| NPI: | 1770532798 |
|---|---|
| Name: | PEDIATRIC PHYSICIAN SERVICES, INC. |
| Entity type: | Organization |
| Organization Name: | PEDIATRIC PHYSICIAN SERVICES, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| 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: | 601 5TH ST S |
| Mailing Address - Street 2: | 5TH FLOOR DEPT 6941 |
| Mailing Address - City: | ST PETERSBURG |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33701 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 727-767-4429 |
| Mailing Address - Fax: | 727-767-4970 |
| Practice Address - Street 1: | 601 5TH ST S |
| Practice Address - Street 2: | DEPARTMENT 6941 |
| Practice Address - City: | ST PETERSBURG |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33701-4804 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 727-767-4429 |
| Practice Address - Fax: | 727-767-4970 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | ALL CHILDRENS HEALTH SYSTEM INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-08 |
| Last Update Date: | 2022-07-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
| No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
| No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental | Group - Multi-Specialty |
| No | 2080P0204X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | Group - Multi-Specialty |
| No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
| No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 21399 | Other | BLUE CROSS BLUE SHIELD |
| FL | 252285316 | Medicaid | |
| FL | 00222 | Other | BLUE SHIELD OF FLORIDA |
| FL | 252285300 | Medicaid | |
| FL | 252285306 | Medicaid | |
| FL | 252285317 | Medicaid | |
| FL | 252285318 | Medicaid | |
| FL | 252285319 | Medicaid | |
| FL | 252285301 | Medicaid | |
| FL | 252285321 | Medicaid | |
| FL | 252285307 | Medicaid | |
| FL | 252285308 | Medicaid | |
| FL | 252285309 | Medicaid | |
| FL | 252285303 | Medicaid | |
| FL | 252285311 | Medicaid |
