Provider Demographics
NPI:1912753575
Name:CHILDREN'S MERCY - WILDWOOD PEDIATRICS
Entity Type:Organization
Organization Name:CHILDREN'S MERCY - WILDWOOD PEDIATRICS
Other - Org Name:WILDWOOD PEDIATRICS - AN AFFILIATE OF CHILDREN'S MERCY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SNR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FINUF
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:816-701-5200
Mailing Address - Street 1:4025 NE LAKEWOOD WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4025 NE LAKEWOOD WAY STE 100
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2058
Practice Address - Country:US
Practice Address - Phone:480-822-0894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty