1265525646 NPI number — WYANDOTTE PEDIATRICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265525646 NPI number — WYANDOTTE PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYANDOTTE PEDIATRICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265525646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8919 PARALLEL PKWY
Provider Second Line Business Mailing Address:
SUITE 380
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66112-1636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-299-3800
Provider Business Mailing Address Fax Number:
913-299-9402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8919 PARALLEL PKWY
Provider Second Line Business Practice Location Address:
SUITE 380
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-3800
Provider Business Practice Location Address Fax Number:
913-299-9402
Provider Enumeration Date:
09/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TICKLES
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
913-299-8300

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14230011 . This is a "BCBS KANSAS CITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 625989 . This is a "BCBS KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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