Basic Information
| Provider Information | |||||||||
| NPI: | 1376732339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDS HEALTHCARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 W GROVE ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751421882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729321319 | ||||||||
| FaxNumber: | 9729321388 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 W GROVE ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751421882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729321319 | ||||||||
| FaxNumber: | 9729321388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2007 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | TURNER | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9729321319 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.