Provider Demographics
NPI:1851580724
Name:CHILDRENS MERCY HOSPITAL
Entity Type:Organization
Organization Name:CHILDRENS MERCY HOSPITAL
Other - Org Name:CHILDRENS MERCY WEST PHARMACY/THE CORDELL MEEKS JR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FINUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-701-5200
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:4313 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3734
Practice Address - Country:US
Practice Address - Phone:913-233-4452
Practice Address - Fax:913-287-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023714333600000X
KS2101413336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080290BMedicaid
2027818OtherPK
MO019813500Medicaid
2027818OtherPK