Provider Demographics
NPI:1942247283
Name:PEDIATRIC PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:PEDIATRIC PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:HOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:913-541-3300
Mailing Address - Street 1:10600 QUIVIRA RD
Mailing Address - Street 2:STE 210
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:STE 210
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-541-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization