St. Augustine Pediatric Associates, Pa

LBN: St. Augustine Pediatric Associates, Pa
St. Augustine Pediatric Associates, Pa is an health care organization with primary practice located at 493 Prosperity Lake Dr , St Augustine FL 32092-5045. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as the primary health care specialty. St. Augustine Pediatric Associates, Pa can be contacted via phone (904) 824-5437, or through Soberano, Michael via phone (904) 824-5437.

Contact Information

Primary practice address
493 Prosperity Lake Dr St Augustine FL 32092-5045
Phone: (904) 824-5437
Fax: (904) 824-7575
Website:
Map and Directions
Authorized official contact:
Name: Soberano, Michael Doctor of Medicine (MD)
Phone: (904) 824-5437

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X ME78696 Florida

Profile Details

NPI number 1447461421
LBN Legal business name St. Augustine Pediatric Associates, Pa
DBA Doing business as
Authorized official Soberano, Michael Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 Yes
Enumeration date May 24th, 2007
Last updated Jul 21st, 2015 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447461421 NPPES
Florida MEDICAID 257545101

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