Healthcare Provider Details

I. General information

NPI: 1548438849
Provider Name (Legal Business Name): KIDHEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 FORSYTHE BYP SUITE 2
MONROE LA
71201-2168
US

IV. Provider business mailing address

PO BOX 2673
WEST MONROE LA
71294-2673
US

V. Phone/Fax

Practice location:
  • Phone: 318-812-0168
  • Fax: 318-812-0170
Mailing address:
  • Phone: 318-812-0168
  • Fax: 318-812-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA SATERFIEL
Title or Position: PARTNER
Credential: NP
Phone: 318-812-0168