Healthcare Provider Details

I. General information

NPI: 1295284933
Provider Name (Legal Business Name): PLATTE COUNTY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 PLATTE FALLS RD
PLATTE CITY MO
64079-7629
US

IV. Provider business mailing address

1104 PLATTE FALLS RD
PLATTE CITY MO
64079-7629
US

V. Phone/Fax

Practice location:
  • Phone: 816-858-5253
  • Fax: 816-858-5205
Mailing address:
  • Phone: 816-858-5253
  • Fax: 816-858-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A LOWRY
Title or Position: OFFICE COORDINATOR
Credential: D.O.
Phone: 816-858-5253