Healthcare Provider Details

I. General information

NPI: 1215165816
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP OF MONTANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-0175
  • Fax: 954-858-0434
Mailing address:
  • Phone: 954-384-0175
  • Fax: 954-858-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NANETTE SANDERS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 800-243-3839