SANFORD PEDIATRIC ASSOCIATES PA; NPI #1124491816

Contact Information

SANFORD PEDIATRIC ASSOCIATES PA

775 HARLEY STRICKLAND BLVD
SUITE 101
ORANGE CITY, FL 32763-7963

Phone: 386-851-0644
Fax: 386-851-0664
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Adolescent Medicine	2080A0000X	37	Physician/Pediatric Medicine

Indicates primary specialty

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NPI Profile & details for SANFORD PEDIATRIC ASSOCIATES PA

NPI Number 1124491816

LBN Legal business name SANFORD PEDIATRIC ASSOCIATES PA

Authorized official JOHN TERWILLEGER - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 11/04/2015

Last updated 11/04/2015 - About 11 years ago

Identifiers

FL	License #	ME0045959
FL	Medicaid	044243700

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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