Provider Demographics
NPI:1427702414
Name:ERTMR PEDIATRICS
Entity type:Organization
Organization Name:ERTMR PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL-ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-670-3618
Mailing Address - Street 1:5261 US HIGHWAY 98S UNIT 8C
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812
Mailing Address - Country:US
Mailing Address - Phone:863-608-3812
Mailing Address - Fax:
Practice Address - Street 1:5261 US HIGHWAY 98S UNIT 8C
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812
Practice Address - Country:US
Practice Address - Phone:863-608-3812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care