C12 Medical LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

C12 MEDICAL LLC

Practice address

333 16TH Ave SE
Largo, FL 33771-4407

Phone

(727) 251-7782

NPI assigned

Nov 8, 2018

Organization subpart

No

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

Authorized official

Name

Christian S Childers

Title

OT

Phone

(727) 251-7782

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541635200000",
    "number": "1972071801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8498 108TH WAY",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724318",
            "telephone_number": "727-251-7782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 16TH AVE SE",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337714407",
            "telephone_number": "727-251-7782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C12 MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-08",
        "last_updated": "2018-11-08",
        "status": "A",
        "authorized_official_last_name": "CHILDERS",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OT",
        "authorized_official_telephone_number": "727-251-7782"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OT10920",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; 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.