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General NPI Number Information
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NPI Number | 1992964845
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE PEDIATRICS PC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 17500 MEDICAL CENTER PKWY SUITE 5
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City | INDEPENDENCE
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State | MO
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Zip | 64057
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Country | US
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Telephone | 816-373-1111
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Fax | 816-378-9222
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Provider Business Mailing Address
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Address Line | 17500 MEDICAL CENTER PKWY SUITE 5
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City | INDEPENDENCE
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State | MO
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Zip | 64057
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Country | US
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Telephone | 816-373-1111
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Fax | 816-378-9222
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TRACEY FARIBORZ
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Credential | LPN
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Telephone | 816-373-1142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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