Provider Demographics
NPI:1831254168
Name:ALL CHILDREN'S SURGIKID OF FLORIDA, INC
Entity type:Organization
Organization Name:ALL CHILDREN'S SURGIKID OF FLORIDA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & COO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALESSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-767-2868
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:DEPT. #9525
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-898-7451
Mailing Address - Fax:727-767-4191
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:DEPT. #9525
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-898-7451
Practice Address - Fax:727-767-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1048261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER
225201OtherPROVIDER ID - AVMED
0636960043OtherPROVIDER ID - CIGNA
FL079228400Medicaid
69MOtherPROVIDER ID - BCBS OF FL
=========OtherTAX ID NUMBER
225201OtherPROVIDER ID - AVMED