Provider Demographics
NPI:1144636861
Name:WEECARE FOR KIDS PA
Entity type:Organization
Organization Name:WEECARE FOR KIDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:THOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-236-9000
Mailing Address - Street 1:11948 BALM RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6601
Mailing Address - Country:US
Mailing Address - Phone:813-236-9000
Mailing Address - Fax:813-236-9002
Practice Address - Street 1:11948 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6601
Practice Address - Country:US
Practice Address - Phone:813-236-9000
Practice Address - Fax:813-236-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
005NBOtherBLUE CROSS BLUE SHIELD
FL005NBMedicaid