Healthcare Provider Details

I. General information

NPI: 1437180171
Provider Name (Legal Business Name): COCKERELL & MCINTOSH PEDIATRIC URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 E WINNER RD
INDEPENDENCE MO
64052-3964
US

IV. Provider business mailing address

205 NW R D MIZE RD SUITE 304
BLUE SPRINGS MO
64014
US

V. Phone/Fax

Practice location:
  • Phone: 816-252-9850
  • Fax:
Mailing address:
  • Phone: 816-228-4770
  • Fax: 816-228-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN E WOOD
Title or Position: GENERAL MANAGER
Credential:
Phone: 816-228-4770