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General NPI Number Information
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NPI Number | 1396016473
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Entity Type | Organization
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Legal Business Name | QUALITY CARE FOR KIDS INDIANA
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 134 N GARDNER ST
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City | SCOTTSBURG
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State | IN
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Zip | 47170-1306
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Country | US
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Telephone | 502-226-3937
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Fax | 502-226-2929
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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 | 502-226-3937
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Fax | 502-226-2929
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELLE RENAE STIVERS
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Credential |
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Telephone | 502-226-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01023950A
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License Number State | IN
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