Provider Demographics
| NPI: | 1649377359 |
|---|---|
| Name: | PEDIATRIX MEDICAL GROUP OF TEXAS BILLING, INC. |
| Entity type: | Organization |
| Organization Name: | PEDIATRIX MEDICAL GROUP OF TEXAS BILLING, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| 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: | 2929 WOODLAND PARK DR |
| Practice Address - Street 2: | |
| Practice Address - City: | HOUSTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77082-2687 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 281-293-7774 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | PEDIATRIX MEDICAL SERVICES INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-09-17 |
| Last Update Date: | 2025-04-07 |
| 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 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084A2900X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurocritical Care | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | Z000U99U2 | Other | MEDICARE |
| TX | 00186R | Other | BCBS |
| TX | 137308631 | Medicaid | |
| TX | 137308637 | Medicaid | |
| TX | 141691903 | Medicaid | |
| TX | 141691908 | Medicaid | |
| TX | 141691909 | Medicaid | |
| TX | 529907870 | Medicaid | |
| 0084A | Other | MEDICARE | |
| TX | 0084AZ | Other | BCBS |
| TX | 137308614 | Medicaid | |
| TX | 137308617 | Medicaid | |
| TX | 141691906 | Medicaid | |
| TX | 187119601 | Medicaid | |
| TX | 95656049 | Medicaid | |
| TX | 0067GW | Other | BCBS |
| TX | 144542104 | Medicaid | |
| TX | 144542105 | Medicaid | |
| TX | 184048701 | Medicaid | |
| TX | 0084AZ | Other | MEDICARE |
| TX | 137308612 | Medicaid | |
| TX | 137308633 | Medicaid | |
| TX | 141606701 | Medicaid | |
| TX | 141691911 | Medicaid | |
| TX | 144542102 | Medicaid | |
| TX | 184818601 | Medicaid | |
| TX | 00059H | Other | BCBS |
| TX | 00059H | Other | MEDICARE |
| TX | 00R66Z | Other | MEDICARE |
| TX | 00U99U | Other | BCBS |
| TX | 137308620 | Medicaid | |
| TX | 137308621 | Medicaid | |
| TX | 137308623 | Medicaid | |
| TX | 141611701 | Medicaid | |
| TX | 141686903 | Medicaid | |
| TX | 141691901 | Medicaid | |
| TX | 141691910 | Medicaid | |
| TX | 144542103 | Medicaid | |
| TX | 169372301 | Medicaid | |
| TX | 177999301 | Medicaid | |
| TX | 289221213A | Medicaid | |
| TX | 529908050 | Medicaid | |
| TX | 8206898 | Other | AETNA |
| TX | 0055BR | Other | BCBS |
| TX | 141691904 | Medicaid | |
| TX | 141691914 | Medicaid | |
| TX | 178099101 | Medicaid | |
| TX | 0055BR | Other | MEDICARE |
| TX | 0098JQ | Other | BCBS |
| TX | 137308619 | Medicaid |
