Provider Demographics
NPI:1134675366
Name:LONE STAR KIDS CARE
Entity Type:Organization
Organization Name:LONE STAR KIDS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-649-5480
Mailing Address - Street 1:1256 W EXCHANGE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7049
Mailing Address - Country:US
Mailing Address - Phone:972-649-5480
Mailing Address - Fax:469-854-6664
Practice Address - Street 1:1256 W EXCHANGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7049
Practice Address - Country:US
Practice Address - Phone:972-649-5480
Practice Address - Fax:469-854-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1354261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1976433Medicaid