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Organization

TLC PEDIATRICS, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ASSAD U SHAFFIEY MD (PRESIDENT)
(660) 829-5852
Entity
Organization

Contact information

Practice address
2925 CLINTON RD, SEDALIA, MO 65301-7915
(660) 829-5852
(660) 829-5854
Mailing address
2925 CLINTON RD, SEDALIA, MO 65301-7915
(660) 829-5852
(660) 829-5854

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
115544
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1200057
UHC
MO
05
18833
MO
01
25282044
BCBS
MO
05
372430
MO
01
392869
HEALTHLINK/FREEDOM NET
MO
05
9518
MO
01
G85947
MERCY
MO
Enumeration date
09/02/2006
Last updated
08/22/2020
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