Provider Demographics
NPI:1306363858
Name:CHILDREN'S MERCY - REDWOOD PEDIATRICS
Entity Type:Organization
Organization Name:CHILDREN'S MERCY - REDWOOD 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 ROAD
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:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:9784 N ASH AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-9742
Practice Address - Country:US
Practice Address - Phone:816-207-0070
Practice Address - Fax:816-256-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010037363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty