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General NPI Number Information
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NPI Number | 1073951356
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Entity Type | Organization
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Legal Business Name | KIDS HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 30 MAIN ST
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1020
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Country | US
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Telephone | 502-229-1744
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Fax |
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Provider Business Mailing Address
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Address Line | 100 DIAGNOSTIC DR
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City | FRANKFORT
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State | KY
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Zip | 40601-6524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANDREW STIVERS
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Credential |
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Telephone | 502-229-1744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 43264
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 40801
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License Number State | KY
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