Provider Demographics
NPI:1427225200
Name:TENNEY PEDIATRICS AND ADOLESCENTS MEDICINE LLC
Entity type:Organization
Organization Name:TENNEY PEDIATRICS AND ADOLESCENTS MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-444-8400
Mailing Address - Street 1:6501 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2732
Mailing Address - Country:US
Mailing Address - Phone:816-444-8400
Mailing Address - Fax:816-444-8407
Practice Address - Street 1:6501 E 87TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-2732
Practice Address - Country:US
Practice Address - Phone:816-444-8400
Practice Address - Fax:816-444-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7FO9174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202260527Medicaid
MO202260527Medicaid