Healthcare Provider Details

I. General information

NPI: 1467559161
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP OF LOUISIANA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E PRESIDENT GEORGE BUSH HWY SUITE 250
RICHARDSON TX
75082-3542
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 972-437-5099
  • Fax: 972-764-1661
Mailing address:
  • Phone: 954-384-0175
  • Fax: 954-851-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ASHFORD
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 800-243-3839