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NPI Code Detail

MEDICARE: KIDS FOR THE FUTURE ROGERS, INC.

MEDICARE: KIDS FOR THE FUTURE ROGERS, INC.
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
1261QD1600XDevelopmental Disabilities Clinic/Center25537AR

General Provider Information

NPI Number : 1508037870
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS FOR THE FUTURE ROGERS, INC.
Provider Business Mailing Address
First Line : PO BOX 130
Second Line :
City : ROGERS
State : AR
Zip : 72757-0130
Country : US
Telephone Number : 479-986-5150
Fax Number : 479-986-5191
Provider Business Practice Location Address
First Line : 3307 N DIXIELAND RD
Second Line :
City : ROGERS
State : AR
Zip : 72756-6816
Country : US
Telephone Number : 479-986-5150
Fax Number : 479-986-5191
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : DR. RICHARD W WILDE
Credential : ED.D.
Telephone Number : 479-986-5150
Provider Enumeration Date : 03/14/2008
Last Update Date : 03/14/2008

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