Healthcare Provider Details

I. General information

NPI: 1801932355
Provider Name (Legal Business Name): OVERLAND PEDIATRICS AND INFECTIOUS DISEASE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CARONDELET DR SUITE 303
KANSAS CITY MO
64114-4855
US

IV. Provider business mailing address

930 CARONDELET DR SUITE 303
KANSAS CITY MO
64114-4855
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-0440
  • Fax: 816-941-9966
Mailing address:
  • Phone: 816-941-0440
  • Fax: 816-941-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0422532
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR1J85
License Number StateMO

VIII. Authorized Official

Name: DR. ARMISA TONGSON CULLENS
Title or Position: CEO
Credential: M.D.
Phone: 816-941-0440