NPIMap

Organization Active NPI

Plant City Pediatrics, PA

  • Pediatrics Physician
  • Plant City, FL
National Provider Identifier
1376609891
Registry record updated Oct 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OS7802 Issued in FL
Legal business name
PLANT CITY PEDIATRICS, PA
Practice address
2370 Walden Woods Dr
Suite a
Plant City, FL 33563-7027
Phone
(813) 659-9800
Fax
(813) 659-9807
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2015

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

Authorized official

Name
Ms. Mary C Kifer
Title
Practice Administrator
Phone
(813) 659-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X OS7802 FL Primary

Addresses

Primary practice location

2370 Walden Woods Dr
Suite a
Plant City, FL 33563-7027

Mailing address

2370 Walden Woods Dr
Suite a
Plant City, FL 33563-7027
Phone (813) 659-9800

Other identifiers 8

IdentifierTypeStateIssuer
1154340115OtherFLNPI
1215909262OtherFLNPI
1851713952MedicaidFL
1609809987OtherFLNPI
1649248956OtherFLPLANT CITY PEDIATRICS
1376609891MedicaidFL
1821065061MedicaidFL
1275706160MedicaidFL

Other names 1

  • Timothy Williams Pediatrics of Brandon Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1004607Plant City Pediatrics2370 Walden Woods Drive, Plant City, FL 33563Certificate of waiverSep 30, 2026

National Provider Directory

National Provider Directory

Locations

2370 Walden Woods Dr
Plant City, FL 33563

2370 Walden Woods Dr
Ste A
Plant City, FL 33563
Phone (813) 659-9800

Practitioners & affiliated clinicians

Practitioners 10

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444867200000",
    "number": "1376609891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2370 WALDEN WOODS DR",
            "address_2": "SUITE A",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "335637027",
            "telephone_number": "813-659-9800",
            "fax_number": "813-659-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2370 WALDEN WOODS DR",
            "address_2": "SUITE A",
            "city": "PLANT CITY",
            "state": "FL",
            "postal_code": "335637027",
            "telephone_number": "813-659-9800",
            "fax_number": "813-659-9807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLANT CITY PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2015-10-15",
        "status": "A",
        "authorized_official_last_name": "KIFER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "813-659-9800",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS7802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1154340115",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1215909262",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851713952",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1609809987",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PLANT CITY PEDIATRICS",
            "identifier": "1649248956",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376609891",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821065061",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275706160",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timothy Williams Pediatrics of Brandon",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Plant City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.