Healthcare Provider Details

I. General information

NPI: 1356090880
Provider Name (Legal Business Name): CHILDREN'S MERCY - PEACOCK PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N 36TH ST STE B
SAINT JOSEPH MO
64506-2954
US

IV. Provider business mailing address

2401 GILLHAM RD ATTN: PROVIDER ENROLLMENT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-396-6026
  • Fax:
Mailing address:
  • Phone: 816-701-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT D FINUF II
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 816-701-5200