Provider Demographics
NPI:1114122900
Name:PEDIATRIX MEDICAL GROUP
Entity Type:Organization
Organization Name:PEDIATRIX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-999-0753
Mailing Address - Street 1:PO BOX 3916
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3916
Mailing Address - Country:US
Mailing Address - Phone:787-999-0753
Mailing Address - Fax:787-999-0790
Practice Address - Street 1:PDA 37 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00902
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-758-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99892080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTAX ID NUMBER