Provider Demographics
NPI:1568486264
Name:OBSTETRIX MEDICAL GROUP OF TEXAS BILLING, INC.
Entity Type:Organization
Organization Name:OBSTETRIX MEDICAL GROUP OF TEXAS BILLING, INC.
Other - Org Name:OBSTETRIX MEDICAL GROUP OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DWYER
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 1:3001 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:SUITE 250
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3542
Practice Address - Country:US
Practice Address - Phone:972-437-5099
Practice Address - Fax:972-764-1661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIX MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00291ZOtherMEDICARE
TX7029142OtherAETNA
TX79601B001OtherTRICARE
TX76015A001OtherTRICARE
TX81106343Medicaid
TX00022KOtherMEDICARE
TX76104A001OtherTRICARE
TX00022KOtherBCBS
TX00454ROtherMEDICARE
TX31438750Medicaid
TX079584101Medicaid
TX100726580AMedicaid
TX100726620AMedicaid
TX177389701Medicaid