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PEDIATRIC SPECIALTY GROUP INC. NPI 1487108320


NPI Information

NPI: 1487108320
Provider Name: PEDIATRIC SPECIALTY GROUP, INC.

Doing Business As: NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS - ADOLESCENT MEDICINE

Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
3100 SW 62ND AVE
SUITE 109
MIAMI, FL
ZIP 33155
Phone: (786) 624-5876
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PEDIATRIC SPECIALTY GROUP, INC. is an adolescent medicine pediatrics in Miami, FL. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PEDIATRIC SPECIALTY GROUP, INC. NPI is 1487108320. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Nicklaus Children's Pediatric Specialists - Adolescent Medicine.

The provider's business location address is:

3100 SW 62ND AVE
SUITE 109
MIAMI, FL
ZIP 33155
Phone: (786) 624-5876
Fax: (786) 624-2688

The provider's authorized official is Robbin Anderson .
The authorized official title is Payer Credentialing Supervisor and has the following contact phone number (786) 624-5747.

The enumeration date for this NPI number is 8/9/2016 and was last updated on 6/16/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsNo
22080A0000XPediatricsAdolescent MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1013515203MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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