Provider Demographics
NPI:1033139571
Name:OBSTERTIX/PEDIATRIX MEDICAL GROUP
Entity Type:Organization
Organization Name:OBSTERTIX/PEDIATRIX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING NEONATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-839-7440
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 5300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-839-7440
Mailing Address - Fax:303-839-7210
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 5300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-839-7440
Practice Address - Fax:303-839-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO427522080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3109577Medicaid
CO3109577Medicaid