Healthcare Provider Details

I. General information

NPI: 1194867390
Provider Name (Legal Business Name): PEDIATRIX,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD 4090
JACKSONVILLE FL
32216-1471
US

IV. Provider business mailing address

5229 RIVER FOREST DR
JACKSONVILLE FL
32211-4553
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7910
  • Fax: 904-296-9081
Mailing address:
  • Phone: 904-745-3614
  • Fax: 904-308-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1053912
License Number StateFL

VIII. Authorized Official

Name: DR. RONALD PETER CARZOLI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 904-393-7910