Healthcare Provider Details

I. General information

NPI: 1104484245
Provider Name (Legal Business Name): CHILDREN'S MERCY-SHAWNEE MISSION PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER LN STE 105
MERRIAM KS
66204-2361
US

IV. Provider business mailing address

2401 GILLHAM RD PROVIDER ENROLLMENT DEPT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 913-362-1660
  • Fax: 913-362-5916
Mailing address:
  • Phone: 816-701-5200
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT D FINUF II
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 816-701-5200