Provider Demographics
NPI:1619404829
Name:DONNER SUMMIT, LLC
Entity Type:Organization
Organization Name:DONNER SUMMIT, LLC
Other - Org Name:THRIVE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLHARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-977-3291
Mailing Address - Street 1:9151 NE 81ST TER SUITE 240
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158
Mailing Address - Country:US
Mailing Address - Phone:816-977-3291
Mailing Address - Fax:
Practice Address - Street 1:9151 NE 81ST TER STE 240
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1307
Practice Address - Country:US
Practice Address - Phone:816-977-3291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010037363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1144458514Medicaid