Provider Demographics
NPI:1962532283
Name:INDEPENDENCE PEDIATRICS, P.C. INC.
Entity type:Organization
Organization Name:INDEPENDENCE PEDIATRICS, P.C. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WELDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-373-1111
Mailing Address - Street 1:4731 S COCHISE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6975
Mailing Address - Country:US
Mailing Address - Phone:816-373-1111
Mailing Address - Fax:816-373-9222
Practice Address - Street 1:4731 S COCHISE DR STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6975
Practice Address - Country:US
Practice Address - Phone:816-373-1111
Practice Address - Fax:816-373-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOJ61A008Medicaid
MOJ619948Medicaid
MOG13096Medicare UPIN
MOH00364Medicare UPIN