Organization · NPI-2

Capernaum Medical Center For Kids PLLC

Clinic/Center · Lakeland, FL

NPI number1417422015
StatusActive
Last updated in NPPESAug 15, 2024

Details

NPI
1417422015
Entity type
Organization (NPI-2)
Legal business name
Capernaum Medical Center For Kids PLLC
Organization subpart
Yes
Enumeration date
Oct 10, 2018
Certification date
Aug 15, 2024
Last updated
Aug 15, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

2024 Edgewood Dr S
Lakeland, FL 33803-3637

Phone 863-232-4323 · Fax 863-337-5728

Mailing address

2024 Edgewood Dr S
Lakeland, FL 33803-3637

Phone 863-232-4323 · Fax 863-337-5728

Other practice locations

3040 Park Pond Way
Kissimmee, FL 34741-7662

Phone 863-232-4323 · Fax 863-337-5728

250 Westshore Plz
Tampa, FL 33609-1811

Phone 863-232-4323 · Fax 863-337-5728

4710 N Habana Ave Ste 404
Tampa, FL 33614-7152

Phone 863-232-4323 · Fax 863-337-5728

5129 S Lakeland Dr Ste 2
Lakeland, FL 33813-2599

Phone 863-232-4323 · Fax 863-337-5728

Authorized official

Eric Roberto Vernier
MD
8136476050

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