Provider Demographics
NPI:1770971541
Name:ST MARY FLORIDA PEDIATRIC CARE PLLC
Entity type:Organization
Organization Name:ST MARY FLORIDA PEDIATRIC CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SALIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-754-1984
Mailing Address - Street 1:2626 TAMPA RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3155
Mailing Address - Country:US
Mailing Address - Phone:727-754-1984
Mailing Address - Fax:757-754-2868
Practice Address - Street 1:2626 TAMPA RD
Practice Address - Street 2:STE 101
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3155
Practice Address - Country:US
Practice Address - Phone:727-754-1984
Practice Address - Fax:757-754-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty