NPIMap

Organization Active NPI

Peacock Pediatrics, LLC

  • Pediatrics Physician
  • Saint Joseph, MO
National Provider Identifier
1598399784
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEACOCK PEDIATRICS, LLC
Practice address
805 N 36TH St Ste B
Saint Joseph, MO 64506-2954
Phone
(816) 396-6026
NPI assigned
Feb 26, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Authorized official

Name
Dr. Amanda D Williams, DONPI 1902079189
Title
Member
Phone
(816) 396-6026

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 Primary

Addresses

Primary practice location

805 N 36TH St Ste B
Saint Joseph, MO 64506-2954

Mailing address

805 N 36TH St Ste B
Saint Joseph, MO 64506-2954
Phone (816) 396-6026

National Provider Directory

National Provider Directory

Locations

805 N 36th St
Ste B
Saint Joseph, MO 64506
Phone (816) 396-6026

Practitioners & affiliated clinicians

Practitioners 6

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": "1582675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587686400000",
    "number": "1598399784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N 36TH ST STE B",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062954",
            "telephone_number": "816-396-6026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 N 36TH ST STE B",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062954",
            "telephone_number": "816-396-6026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-26",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "816-396-6026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "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 Apr 24, 2020; 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.