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EXCELSIOR SPRINGS PEDIATRIC CLINIC NPI 1568750420


NPI Information

NPI: 1568750420
Provider Name: EXCELSIOR SPRINGS PEDIATRIC CLINIC
Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
1006 N JESSE JAMES RD
STE 2
EXCELSIOR SPRINGS, MO
ZIP 64024
Phone: (816) 637-0117
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EXCELSIOR SPRINGS PEDIATRIC CLINIC is a pediatrics in Excelsior Springs, MO. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. EXCELSIOR SPRINGS PEDIATRIC CLINIC NPI is 1568750420. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1006 N JESSE JAMES RD
STE 2
EXCELSIOR SPRINGS, MO
ZIP 64024-202
Phone: (816) 637-0117
Fax: (816) 637-0814

The provider's authorized official is Kelli L Bowman .
The authorized official title is Office Manager and has the following contact phone number (816) 637-0117.

The enumeration date for this NPI number is 7/13/2011 and was last updated on 7/13/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363LF0000XNurse PractitionerFamily2011006205MISSOURINo
2208000000XPediatricsR6H00MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1202518809MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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