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Organization

SUMMIT PEDIATRICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TAMARA L PETERSON D.O. (GENERAL PEDIATRICIAN/MANAGER)
(816) 525-2800
Entity
Organization

Contact information

Practice address
3171 NE CARNEGIE DR, SUITE A, LEES SUMMIT, MO 64064-3215
(816) 525-2800
(816) 525-4077
Mailing address
3171 NE CARNEGIE DR, SUITE A, LEES SUMMIT, MO 64064-3215
(816) 525-2800
(816) 525-4077

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2008015364
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NA
NA
Enumeration date
03/21/2012
Last updated
04/26/2016
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