Organization
COCKERELL & MCINTOSH PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN E WOOD (GENERAL MANAGER)
(816) 228-4770
Entity
Organization
Contact information
Practice address
205 NW RD MIZE RD, SUITE 304, BLUE SPRINGS, MO 64014-2518
(816) 228-4770
(816) 228-1156
Mailing address
205 NW R D MIZE RD, SUITE 304, BLUE SPRINGS, MO 64014-2518
(816) 228-4770
(816) 228-1156
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11862021
BCBS GROUP NUMBER
MO
Enumeration date
11/14/2006
Last updated
01/31/2011
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