1346347051 NPI number — PEDIATRIX MEDICAL GROUP OF KANSAS PA

Table of content: (NPI 1346347051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346347051 NPI number — PEDIATRIX MEDICAL GROUP OF KANSAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIX MEDICAL GROUP OF KANSAS PA
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:
1346347051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2024
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:
550 N HILLSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67214-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-962-8550
Provider Business Practice Location Address Fax Number:
316-962-8581
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAUTISTA-NAVARRO
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-243-3839

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100216930A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100216930C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100216930D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100216930B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100216930F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100216930E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149977992 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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