Healthcare Provider Details

I. General information

NPI: 1417492828
Provider Name (Legal Business Name): CHILDREN'S MERCY-PEDIATRIC CARE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12541 FOSTER ST SUITE 260
OVERLAND PARK KS
66213-2630
US

IV. Provider business mailing address

12541 FOSTER ST SUITE 260
OVERLAND PARK KS
66213-2630
US

V. Phone/Fax

Practice location:
  • Phone: 913-906-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: VICE PRESIDENT
Credential:
Phone: 816-559-9370