Provider Demographics
NPI:1578665451
Name:TLC PEDIATRICS, PC
Entity Type:Organization
Organization Name:TLC PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASSAD
Authorized Official - Middle Name:U
Authorized Official - Last Name:SHAFFIEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-829-5852
Mailing Address - Street 1:2925 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7915
Mailing Address - Country:US
Mailing Address - Phone:660-829-5852
Mailing Address - Fax:660-829-5854
Practice Address - Street 1:2925 CLINTON RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7915
Practice Address - Country:US
Practice Address - Phone:660-829-5852
Practice Address - Fax:660-829-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115544261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG85947OtherMERCY
MO372430Medicaid
MO1200057OtherUHC
MO18833Medicaid
MO25282044OtherBCBS
MO392869OtherHEALTHLINK/FREEDOM NET
MO9518Medicaid
MO=========OtherCIGNA