1083711790 NPI number — PEDIATRIX MEDICAL GROUP OF FLORIDA INC

Table of content: (NPI 1083711790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083711790 NPI number — PEDIATRIX MEDICAL GROUP OF FLORIDA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIX MEDICAL GROUP OF FLORIDA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083711790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CONCORD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-384-0175
Provider Business Mailing Address Fax Number:
954-851-1948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 CONCORD TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33323-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-384-0175
Provider Business Practice Location Address Fax Number:
954-851-1948
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
800-243-3839

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0008X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0205X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2088P0231X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002741907 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741924 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741938 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741940 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741947 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060035198 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741914 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741927 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741935 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741936 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741908 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741920 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741937 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741945 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741946 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741951 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060035156 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060035176 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002741919 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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