Provider Demographics
NPI:1235276866
Name:SPECIAL CARE FOR SPECIAL KIDS INC
Entity Type:Organization
Organization Name:SPECIAL CARE FOR SPECIAL KIDS INC
Other - Org Name:SPECIAL CARE FOR SPECIAL KIDS AND ADULT PREVENTIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAROLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-466-1892
Mailing Address - Street 1:702 13TH ST
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4075
Mailing Address - Country:US
Mailing Address - Phone:336-466-1892
Mailing Address - Fax:336-667-4515
Practice Address - Street 1:702 13TH ST
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4075
Practice Address - Country:US
Practice Address - Phone:336-466-1892
Practice Address - Fax:336-667-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8917172Medicaid
NCC81249Medicare UPIN