Provider Demographics
NPI:1336693274
Name:PEDIATRIC SPECIALTY GROUP, INC.
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALTY GROUP, INC.
Other - Org Name:PEDIATRIC SPECIALISTS OF AMERICA- NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-624-5715
Mailing Address - Street 1:PO BOX 865095
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-5095
Mailing Address - Country:US
Mailing Address - Phone:786-624-5876
Mailing Address - Fax:786-624-2688
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:786-624-5876
Practice Address - Fax:786-624-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty