Kids Care Pediatrics,PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

KIDS CARE PEDIATRICS,PA

Doing business as

Kids Care Pediatrics Rural Health Clinic

Practice address

6910 Old Wolf Bay Rd
Palatka, FL 32177-6800

Phone

(386) 328-7337

Fax

(386) 325-3742

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Owen Mark Rosenberg

Title

Practice Advisor

Phone

(386) 328-7337

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kids Care Pediatrics Rural Health Clinic Doing business as

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1518044528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6910 OLD WOLF BAY RD",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321776800",
            "telephone_number": "386-328-7337",
            "fax_number": "386-325-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6910 OLD WOLF BAY RD",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321776800",
            "telephone_number": "386-328-7337",
            "fax_number": "386-325-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS CARE PEDIATRICS,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A",
        "authorized_official_last_name": "ROSENBERG",
        "authorized_official_first_name": "OWEN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRACTICE ADVISOR",
        "authorized_official_telephone_number": "386-328-7337"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107889600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Care Pediatrics Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kids Care Pediatrics Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandon Kelly, CNA
• Christopher Kennedy, RPT
• Kepler Enterprises, LLC (BodyMax Physical Therapy)
• Casey R Key, MA, CCC-SLP
• Kids Care Pediatrics,PA
• Jeb Kincannon, DPT
• Angela Nicole King, LMT
• Gail King, PHARM D, MBA
• Sarabeth Kirkland, SLPD, CCC-SLP
• Kiva of Palatka

• Rural Health Clinic/Center in Palatka, FL
• Providers in Palatka, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.