1427496637 NPI number — CHRISTIAN L KIDD CASE MANAGER CARE CO

Table of content: CHRISTIAN L KIDD CASE MANAGER CARE CO (NPI 1427496637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427496637 NPI number — CHRISTIAN L KIDD CASE MANAGER CARE CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIDD
Provider First Name:
CHRISTIAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CASE MANAGER CARE CO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427496637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 ROBERTS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-367-2461
Provider Business Mailing Address Fax Number:
870-460-6133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1802 HWY 82 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSSETT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-364-7248
Provider Business Practice Location Address Fax Number:
870-364-2249
Provider Enumeration Date:
06/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com