Basic Information
| Provider Information | |||||||||
| NPI: | 1760589873 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KID CARE, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 991 MEDICAL PARK DR STE 107 | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410568766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067595437 | ||||||||
| FaxNumber: | 6067599267 | ||||||||
| Practice Location | |||||||||
| Address1: | 991 MEDICAL PARK DR STE 107 | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410568766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067595437 | ||||||||
| FaxNumber: | 6067599267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCDOWELL | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6067595437 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 65900797 | 05 | KY | MEDICAID |