NPIMap

Organization Active NPI

Kids Talk Place LLC

  • Clinic/Center
  • Crestview, FL
National Provider Identifier
1932861234
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
KIDS TALK PLACE LLC
Practice address
4100 S Ferdon Blvd Ste A1
Crestview, FL 32536-5287
Phone
(850) 682-8388
NPI assigned
Oct 13, 2021
Last updated
Nov 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Authorized official

Name
Marjorie M SmithNPI 1760402788
Title
Owner
Phone
(850) 982-5798

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Hearing and Speech Clinic/Center 261QH0700X NU
Multi-Specialty Clinic/Center 261QM1300X NU

Addresses

Primary practice location

4100 S Ferdon Blvd Ste A1
Crestview, FL 32536-5287

Mailing address

4624 Summerdale Dr
Pace, FL 32571-1368
Phone (850) 994-3456

Other identifiers 4

IdentifierTypeStateIssuer
9ZBKJOtherBCBS
812245800MedicaidFL
889624100MedicaidFL
889624104MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Kids Talk Place2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4624 Summerdale Blvd
Pace, FL 32571
Phone (850) 994-3456

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1932861234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 SUMMERDALE DR",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325711368",
            "telephone_number": "850-994-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 S FERDON BLVD STE A1",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325365287",
            "telephone_number": "850-682-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS TALK PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-13",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MARJORIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-982-5798"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9ZBKJ",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "812245800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "889624100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "889624104",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; 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.