Healthcare Provider Details

I. General information

NPI: 1558391698
Provider Name (Legal Business Name): PEDIATRIC CARE NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 NW BARRY RD SUITE 200
KANSAS CITY MO
64154-1493
US

IV. Provider business mailing address

5810 NW BARRY RD SUITE 200
KANSAS CITY MO
64154-1493
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-3200
  • Fax: 816-587-7644
Mailing address:
  • Phone: 816-587-3200
  • Fax: 816-587-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR4H36
License Number StateMO

VIII. Authorized Official

Name: MRS. CYNTHIA M MCCONNELL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 816-587-3200