1801297452 NPI number — PRIORITY CARE PEDIATRICS, LLC LIBERTY

Table of content: (NPI 1801297452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801297452 NPI number — PRIORITY CARE PEDIATRICS, LLC LIBERTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY CARE PEDIATRICS, LLC LIBERTY
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:
PRIORITY CARE PEDIATRICS, LLC
Provider Other Organization Name Type Code:
3
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:
1801297452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9405 N OAK TRFY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64155-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-412-2900
Provider Business Mailing Address Fax Number:
816-412-2915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 NE 96TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-412-2900
Provider Business Practice Location Address Fax Number:
816-412-2915
Provider Enumeration Date:
09/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GRIMES
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
MANAGING MEMEBER
Authorized Official Telephone Number:
816-412-2900

Provider Taxonomy Codes

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

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





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