Provider Demographics
NPI: | 1497852107 |
---|---|
Name: | PEDIATRIX MEDICAL GROUP OF TENNESSEE, P.C. |
Entity Type: | Organization |
Organization Name: | PEDIATRIX MEDICAL GROUP OF TENNESSEE, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ASSISTANT SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUZANNE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HECK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 954-384-0175 |
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: | 2023-10-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 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 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | Pediatric 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 | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LN0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | Group - Multi-Specialty |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3718100 | Medicaid | |
KY | 65940041 | Medicaid | |
TN | 3718100 | Medicaid |