Basic Information
| Provider Information | |||||||||
| NPI: | 1710213525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALL CHILDREN'S OB/GYN SPECIALISTS | ||||||||
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| OtherOrganizationName: | WEST COAST NEONATALOGY, INC. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 946298 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303946298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446060 | ||||||||
| FaxNumber: | 7273694030 | ||||||||
| Practice Location | |||||||||
| Address1: | 5959 CENTRAL AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337108502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446060 | ||||||||
| FaxNumber: | 7273475586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2009 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCHULHOF | ||||||||
| AuthorizedOfficialFirstName: | KRISTY | ||||||||
| AuthorizedOfficialMiddleName: | ALICIA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7278987451 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WEST COAST NEONATOLOGY, INC. | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 60-414 | FL | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 251391902 | 05 | FL | MEDICAID |