Provider Demographics
NPI:1659638849
Name:PEDIATRIC INTENSIVIST GROUP LLC
Entity Type:Organization
Organization Name:PEDIATRIC INTENSIVIST GROUP LLC
Other - Org Name:PEDIATRIC INTENSIVIST GROUP- LAWNWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES, HCA
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-767-5716
Mailing Address - Street 1:111 JFK DR STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6634
Mailing Address - Country:US
Mailing Address - Phone:954-767-5716
Mailing Address - Fax:
Practice Address - Street 1:1700 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4803
Practice Address - Country:US
Practice Address - Phone:720-530-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty