Provider Demographics
NPI:1619078912
Name:KANSAS CITY PEDIATRICS, LLC
Entity Type:Organization
Organization Name:KANSAS CITY PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-941-6400
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4802
Mailing Address - Country:US
Mailing Address - Phone:816-941-6400
Mailing Address - Fax:816-941-6404
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 330
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-941-6400
Practice Address - Fax:816-941-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty