Cockerell & McIntosh Pediatrics PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

COCKERELL & MCINTOSH PEDIATRICS PC

Practice address

205 NW Rd Mize Rd
Suite 304
Blue Springs, MO 64014-2518

Phone

(816) 228-4770

Fax

(816) 228-1156

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Bryan E Wood

Title

General Manager

Phone

(816) 228-4770

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Cockerell McIntosh Pediatric Urgent Ca2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cockerell & McIntosh Pediatrics, PC

  • Pediatric Nurse Practitioner
  • Blue Springs, MO
  • NPI 1629517107
  NPD tax ID

Locations

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1124190632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 NW R D MIZE RD",
            "address_2": "SUITE 304",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142518",
            "telephone_number": "816-228-4770",
            "fax_number": "816-228-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 NW RD MIZE RD",
            "address_2": "SUITE 304",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142518",
            "telephone_number": "816-228-4770",
            "fax_number": "816-228-1156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COCKERELL & MCINTOSH PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "816-228-4770"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "11862021",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CMC Behavioral Health Services LLC
• CMC Chiropractic LLC
• CMC Comprehensive Care Blue Springs LLC
• CMC Physical and Occupational Therapy
• CMC Walk in Med BS LLC
• Cockerell & McIntosh Pediatrics, PC
• Charles Frederick Cockerell, MD
• Heather Lynn Colbert
• Tatum Brianne Colburn, DO
• Sara Jane Cole, PSY.D.

• Primary Care Clinic/Center in Blue Springs, MO
• Providers in Blue Springs, MO by specialty
• Primary Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.