Healthcare Provider Details

I. General information

NPI: 1598138984
Provider Name (Legal Business Name): SHERIDAN CHILDREN'S HEALTHCARE SERVICES OF KENTUCKY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

PO BOX 450249
SUNRISE FL
33345-0249
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-2444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT COWARD
Title or Position: PRESIDENT
Credential:
Phone: 954-838-2371