HEARTLAND PEDIATRICS ASSOCIATION OF WAUCHULA P.A. NPI 1144241134

NPI Information

NPI: 1144241134
Provider Name: HEARTLAND PEDIATRICS ASSOCIATION OF WAUCHULA, P.A.
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 10D0880459

Address:
120 HEARTLAND WAY
WAUCHULA, FL
ZIP 33873
Phone: (863) 767-1414
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HEARTLAND PEDIATRICS ASSOCIATION OF WAUCHULA, P.A. is a rural health clinic center in Wauchula, FL. HEARTLAND PEDIATRICS ASSOCIATION OF WAUCHULA, P.A. NPI is 1144241134. The provider is registered as an organization entity type.

The provider's business location address is:

120 HEARTLAND WAY
WAUCHULA, FL
ZIP 33873-000
Phone: (863) 767-1414
Fax: (863) 767-1763

The provider's authorized official is Apurba Manik .
The authorized official title is President and has the following contact phone number (863) 767-1414.

The CLIA number assigned to this NPI record is 10D0880459 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/22/2006 and was last updated on 7/16/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	054605402	MEDICAID	FLORIDA
2	660018201	MEDICAID	FLORIDA
3	33881	OTHER	FLORIDA	BLUECROSS BLUE SHIELD OF FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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