NPIMap

Organization Active NPI

Evans Pediatric Clinic PC

  • Pediatrics Physician
  • Saint Joseph, MO
National Provider Identifier
1013952886
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
110143 Issued in MO
Legal business name
EVANS PEDIATRIC CLINIC PC
Practice address
3912 Sherman Ave
Saint Joseph, MO 64506-3648
Phone
(816) 233-5959
Fax
(816) 233-5960
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Douglas Eugene Evans, D.O.NPI 1871591768
Title
Owner
Phone
(816) 351-6385

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 110143 MO Primary

Addresses

Primary practice location

3912 Sherman Ave
Saint Joseph, MO 64506-3648

Mailing address

3912 Sherman Ave
Saint Joseph, MO 64506-3648
Phone (816) 233-5959

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1013952886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3912 SHERMAN AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063648",
            "telephone_number": "816-233-5959",
            "fax_number": "816-233-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3912 SHERMAN AVE",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063648",
            "telephone_number": "816-233-5959",
            "fax_number": "816-233-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS PEDIATRIC CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-351-6385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "110143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.