Provider Demographics
| NPI: | 1083711790 |
|---|---|
| Name: | PEDIATRIX MEDICAL GROUP OF FLORIDA INC |
| Entity type: | Organization |
| Organization Name: | PEDIATRIX MEDICAL GROUP OF FLORIDA INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NICHOLAS |
| Authorized Official - Middle Name: | E |
| Authorized Official - Last Name: | GLASER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 800-243-3839 |
| Mailing Address - Street 1: | 1301 CONCORD TER |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SUNRISE |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33323-2843 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 954-384-0175 |
| Mailing Address - Fax: | 954-851-1948 |
| Practice Address - Street 1: | 1301 CONCORD TER |
| Practice Address - Street 2: | |
| Practice Address - City: | SUNRISE |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33323-2843 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 954-384-0175 |
| Practice Address - Fax: | 954-851-1948 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-09-17 |
| Last Update Date: | 2024-11-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
| No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2088P0231X | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | Group - Multi-Specialty |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
| No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
| No | 2080P0008X | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities | Group - Multi-Specialty |
| No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 002741907 | Medicaid | |
| FL | 002741935 | Medicaid | |
| FL | 002741936 | Medicaid | |
| FL | 002741947 | Medicaid | |
| FL | 002741951 | Medicaid | |
| FL | 002741956 | Medicaid | |
| FL | 060035176 | Medicaid | |
| FL | 002741937 | Medicaid | |
| FL | 060035156 | Medicaid | |
| FL | 002741900 | Medicaid | |
| FL | 002741923 | Medicaid | |
| FL | 002741925 | Medicaid | |
| FL | 002741930 | Medicaid | |
| FL | 002741948 | Medicaid | |
| FL | 060035157 | Medicaid | |
| FL | 060035169 | Medicaid | |
| FL | 002741914 | Medicaid | |
| FL | 002741931 | Medicaid | |
| FL | 002741938 | Medicaid | |
| FL | 002741945 | Medicaid | |
| FL | 002741905 | Medicaid | |
| FL | 002741906 | Medicaid | |
| FL | 002741920 | Medicaid | |
| FL | 002741939 | Medicaid | |
| FL | 002741941 | Medicaid | |
| FL | 002741942 | Medicaid | |
| FL | 002741944 | Medicaid | |
| FL | 002741958 | Medicaid | |
| FL | 060035198 | Medicaid | |
| FL | 269595221 | Medicaid | |
| FL | 002741908 | Medicaid | |
| FL | 002741912 | Medicaid | |
| FL | 002741919 | Medicaid | |
| FL | 002741926 | Medicaid | |
| FL | 002741929 | Medicaid | |
| FL | 002741903 | Medicaid | |
| FL | 002741911 | Medicaid | |
| FL | 002741913 | Medicaid | |
| FL | 002741924 | Medicaid | |
| FL | 002741934 | Medicaid | |
| FL | 002741940 | Medicaid | |
| FL | 002741946 | Medicaid | |
| FL | 002741910 | Medicaid | |
| FL | 002741922 | Medicaid | |
| FL | 002741927 | Medicaid | |
| FL | 002741932 | Medicaid | |
| FL | 002741927 | Medicaid | |
| FL | 002741941 | Medicaid | |
| FL | 002741956 | Medicaid | |
| FL | 99364C | Medicare PIN |
