Organization
PEDIATRIC CARE IRRV TRUST
Active
Parent organization
STORMONT-VAIL HEALTHCARE INC
Other names
PediatricCare
Organization subpart
Yes
Provider details
NPI number
Legal business name
STORMONT-VAIL HEALTHCARE INC
Authorized official
MS. DEBRA YOCUM CPA (VICE PRESIDENT)
(785) 354-9591
Entity
Organization
Contact information
Practice address
4100 SW 15TH ST, TOPEKA, KS 66604-4333
(785) 273-8224
(785) 273-0524
Mailing address
4100 SW 15TH ST, TOPEKA, KS 66604-4333
(785) 273-8224
(785) 273-0524
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100278070A
—
KS
01
—
KA2129
MEDICARE PTAN
KS
Enumeration date
09/20/2006
Last updated
06/19/2014
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