Provider Demographics
NPI:1114540085
Name:CHILDREN'S MERCY-COMMUNITY CHOICE PEDIATRICS
Entity Type:Organization
Organization Name:CHILDREN'S MERCY-COMMUNITY CHOICE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FINUF
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:816-701-5200
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5201
Mailing Address - Fax:
Practice Address - Street 1:1425 NW BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5705
Practice Address - Country:US
Practice Address - Phone:816-701-5200
Practice Address - Fax:816-302-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty