Organization
CHILDREN AND TEENAGERS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DODSON (MANAGER)
(620) 231-2490
Entity
Organization
Contact information
Practice address
2401 S. TUCKER AVE., SUITE 4, PITTSBURG, KS 66762
(620) 231-2490
(620) 231-3920
Mailing address
2401 S. TUCKER AVE, SUITE 4, PITTSBURG, KS 66762
(620) 231-2490
(620) 231-3920
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270880A
—
KS
Enumeration date
03/08/2007
Last updated
03/01/2016
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