1790352581 NPI number — PEDIATRIX MEDICAL GROUP OF FLORIDA INC

Table of content: (NPI 1790352581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790352581 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:
1790352581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
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:
800-243-3839
Provider Business Mailing Address Fax Number:
855-527-5510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 JUPITER LAKES BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-7196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-844-9858
Provider Business Practice Location Address Fax Number:
855-527-5510
Provider Enumeration Date:
06/09/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GLASER
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-243-3839

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14449188 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014449188 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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