Healthcare Provider Details

I. General information

NPI: 1972554962
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 03/03/2016
Certification Date:
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

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

V. Phone/Fax

Practice location:
  • Phone: 972-437-5099
  • Fax:
Mailing address:
  • Phone: 972-437-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number676602
License Number StateTX

VIII. Authorized Official

Name: MS. NANCY ELLEN FLAVIN
Title or Position: NEONATAL NURSE PRACTITONER
Credential: RNC, MSN, NNP
Phone: 972-437-5099