Healthcare Provider Details

I. General information

NPI: 1477508323
Provider Name (Legal Business Name): VILLAGE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 MISSION RD SUITE 100
PRAIRIE VILLAGE KS
66206-1355
US

IV. Provider business mailing address

8340 MISSION RD SUITE 100
PRAIRIE VILLAGE KS
66206-1355
US

V. Phone/Fax

Practice location:
  • Phone: 913-642-2100
  • Fax: 913-642-2127
Mailing address:
  • Phone: 913-642-2100
  • Fax: 913-642-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JANICE ANN CHERNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 913-642-2100