Organization
HEARTLAND PEDIATRICS ASSOCIATION OF WAUCHULA, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
APURBA MANIK MD (PRESIDENT)
(863) 767-1414
Entity
Organization
Contact information
Practice address
120 HEARTLAND WAY, WAUCHULA, FL 33873-5000
(863) 767-1414
(863) 767-1763
Mailing address
120 HEARTLAND WAY, WAUCHULA, FL 33873-5000
(863) 767-1414
(863) 767-1763
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054605402
—
FL
01
—
33881
BLUECROSS BLUE SHIELD OF FLORIDA
FL
05
—
660018201
—
FL
Enumeration date
07/22/2006
Last updated
07/16/2020
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