Provider Demographics
NPI:1609946383
Name:PEDIATRIC PARTNERS,P.A.
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-888-4567
Mailing Address - Street 1:7301 W 133RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4750
Mailing Address - Country:US
Mailing Address - Phone:913-888-4567
Mailing Address - Fax:913-888-1277
Practice Address - Street 1:7301 W 133RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4750
Practice Address - Country:US
Practice Address - Phone:913-888-4567
Practice Address - Fax:913-888-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0517101208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty