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General NPI Number Information
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NPI Number | 1467469072
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Entity Type | Organization
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Legal Business Name | PEDIATRIC EMERGENCY NETWORK PA
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 975 BAPTIST WAY
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City | HOMESTEAD
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State | FL
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Zip | 33033-7600
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Country | US
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Telephone | 954-583-9995
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Fax | 954-321-3832
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Provider Business Mailing Address
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Address Line | PO BOX 198483
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City | ATLANTA
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State | GA
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Zip | 30384-8483
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Country | US
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Telephone | 954-583-9995
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Fax | 954-321-3832
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Authorized Official
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Title or Position | DIRECTOR
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Name | FRANCISCO MEDINA MEJIA
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Credential | MD
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Telephone | 786-243-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | ME53534
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License Number State | FL
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