Imagine Pediatrics Of Florida Llc
Legal Business Name
Imagine Pediatrics Of Florida Llc
NPI Number
1104542232
NPI Type
Organization
Enumeration Date
10/19/2022
Specialties
(Taxonomies)Name
Code
363LP0222X
363LF0000X
207R00000X
106H00000X
363L00000X
363LP0200X
183500000X
133V00000X
104100000X
Primary Taxonomy
No
No
No
No
No
No
No
No
No
Contact
Information
Purpose
Mailing
Location
Address
220 ATHENS WAY STE 240
3109 W DR MARTIN LUTHER KING JR BLVD STE 350
City
Nashville
Tampa
State
TN
FL
Postal Code
37228-1311
33607-6208
Country
US
US
Telephone Number
(504) 470-4140
(833) 208-7770
Authorized Official
Name
Kenneth Beery
Title or Position
CHIEF ADMIN. OFFICER (CAO)
Telephone Number
(504) 470-4140
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 02/06/2024