Ag Pediatrics, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME110635 Issued in FL

Legal business name

AG PEDIATRICS, LLC

Doing business as

ST. THOMAS PEDIATRIC ASSOCIATE

Practice address

7645 Cita LN Unit 102
New Port Richey, FL 34653-6220

Phone

(727) 261-6464

Fax

(727) 261-6458

NPI assigned

Dec 27, 2017

Organization subpart

No

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

Authorized official

Name

Reda Awad, MD

Title

Owner

Phone

(727) 261-6464

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ST. THOMAS PEDIATRIC ASSOCIATE Doing business as

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

{
    "created_epoch": "1514332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514332800000",
    "number": "1891201919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7645 CITA LN UNIT 102",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346536220",
            "telephone_number": "727-261-6464",
            "fax_number": "727-261-6458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7645 CITA LN UNIT 102",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346536220",
            "telephone_number": "727-261-6464",
            "fax_number": "727-261-6458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AG PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-27",
        "last_updated": "2017-12-27",
        "status": "A",
        "authorized_official_last_name": "AWAD",
        "authorized_official_first_name": "REDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-261-6464",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME110635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010501900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. THOMAS PEDIATRIC ASSOCIATE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2017; 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.