Provider Demographics
NPI:1346215282
Name:JOHNSON COUNTY PEDIATRICS, PA
Entity Type:Organization
Organization Name:JOHNSON COUNTY PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-384-5500
Mailing Address - Street 1:8800 W 75TH STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204
Mailing Address - Country:US
Mailing Address - Phone:913-384-5500
Mailing Address - Fax:913-384-5209
Practice Address - Street 1:8800 W 75TH STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204
Practice Address - Country:US
Practice Address - Phone:913-384-5500
Practice Address - Fax:913-384-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty