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General NPI Number Information
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NPI Number | 1700151818
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Entity Type | Organization
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Legal Business Name | SUMMIT PEDIATRICS, LLC
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 3171 NE CARNEGIE DR SUITE A
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City | LEES SUMMIT
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State | MO
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Zip | 64064-3215
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Country | US
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Telephone | 816-525-2800
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Fax | 816-525-4077
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Provider Business Mailing Address
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Address Line | 3171 NE CARNEGIE DR SUITE A
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City | LEES SUMMIT
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State | MO
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Zip | 64064-3215
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Country | US
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Telephone | 816-525-2800
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Fax | 816-525-4077
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Authorized Official
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Title or Position | GENERAL PEDIATRICIAN/MANAGER
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Name | DR. TAMARA L PETERSON
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Credential | D.O.
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Telephone | 816-525-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2008015364
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License Number State | MO
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