MEDICARE: FIREFLY PEDIATRICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	P3769	TX
2	208000000X	Pediatrics Physician	P3769	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952727109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIREFLY PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	2148 JACKSON KELLER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2722
Country	:	US
Telephone Number	:	210-501-0703
Fax Number	:	210-526-0334

Provider Business Practice Location Address
First Line	:	2148 JACKSON KELLER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2722
Country	:	US
Telephone Number	:	210-501-0703
Fax Number	:	210-526-0334

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL LEE SEGURA
Credential	:	MBA
Telephone Number	:	512-940-1027

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	12/09/2014

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Directions to “FIREFLY PEDIATRICS, PLLC ” Practice Location

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