Provider Demographics
NPI:1265491997
Name:CHILDREN'S HEALTH SERVICES, P.A.
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHEADLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-329-1474
Mailing Address - Street 1:1826 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-329-7337
Mailing Address - Fax:252-329-1477
Practice Address - Street 1:1826 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-329-7337
Practice Address - Fax:252-329-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890113MMedicaid