Provider Demographics
NPI:1902128259
Name:PREMIER PEDIATRICS, PA
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WINBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-261-3153
Mailing Address - Street 1:5800 FOXRIDGE DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2347
Mailing Address - Country:US
Mailing Address - Phone:913-261-3153
Mailing Address - Fax:913-262-3295
Practice Address - Street 1:8675 COLLEGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1946
Practice Address - Country:US
Practice Address - Phone:913-261-3153
Practice Address - Fax:913-262-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27906208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty