Provider Demographics
NPI:1952727109
Name:FIREFLY PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:FIREFLY PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:512-940-1027
Mailing Address - Street 1:2148 JACKSON KELLER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2722
Mailing Address - Country:US
Mailing Address - Phone:210-501-0703
Mailing Address - Fax:210-526-0334
Practice Address - Street 1:2148 JACKSON KELLER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2722
Practice Address - Country:US
Practice Address - Phone:210-501-0703
Practice Address - Fax:210-526-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3769208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX336517301Medicaid