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NPI Code Detail

MEDICARE: DR. ED W. CHILDS M.D.

MEDICARE: DR. ED W. CHILDS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianH7963TX
2208600000XSurgery Physician067203GA
3208600000XSurgery PhysicianE-19369AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2020048105OTHERTXRR/MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30457251-02OTHERTXCSHCN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
58A6942OTHERTXBLUE SHIELD

General Provider Information

NPI Number : 1144280116
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ED W. CHILDS M.D.
Provider Business Mailing Address
First Line : PO BOX 776084
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6084
Country : US
Telephone Number : 479-273-7700
Fax Number : 479-464-7734
Provider Business Practice Location Address
First Line : 1001 S HORSEBARN RD
Second Line :
City : ROGERS
State : AR
Zip : 72758-8184
Country : US
Telephone Number : 479-273-7700
Fax Number : 479-464-7734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 06/04/2025

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Directions to “ DR. ED W. CHILDS M.D.” Practice Location

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