NPIMap

Organization Active NPI

Pediatric Surgical Group, P.a.

  • Pediatric Surgery Physician
  • St Petersburg, FL
National Provider Identifier
1033194816
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
ME0055290 Issued in FL
Legal business name
PEDIATRIC SURGICAL GROUP, P.A.
Practice address
880 6TH St S
Suite 210
St Petersburg, FL 33701-4827
Phone
(727) 767-4170
Fax
(727) 767-4346
NPI assigned
Dec 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Cathy Clark
Title
Practice Manager
Phone
(727) 767-3221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0120X ME0055290 FL Primary

Addresses

Primary practice location

880 6TH St S
Suite 210
St Petersburg, FL 33701-4827

Mailing address

880 6TH St S
Suite 210
St Petersburg, FL 33701-4827
Phone (727) 767-4170

National Provider Directory

National Provider Directory

Locations

801 6th St S
Ste 210
St Petersburg, FL 33701

880 6th St S
Ste 210
St Petersburg, FL 33701
Phone (727) 767-4170

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033194816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 6TH ST S",
            "address_2": "SUITE 210",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014827",
            "telephone_number": "727-767-4170",
            "fax_number": "727-767-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 6TH ST S",
            "address_2": "SUITE 210",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014827",
            "telephone_number": "727-767-4170",
            "fax_number": "727-767-4346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SURGICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "727-767-3221",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": "FL",
            "license": "ME0055290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.