Provider Demographics
NPI:1346649894
Name:KIDS CARE MEDICAL CENTER
Entity Type:Organization
Organization Name:KIDS CARE MEDICAL CENTER
Other - Org Name:JAMES L. COWAN, M. D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LANGSTON
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:901-365-2555
Mailing Address - Street 1:6073 MT MORIAH RD EXT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2666
Mailing Address - Country:US
Mailing Address - Phone:901-365-2555
Mailing Address - Fax:901-365-2544
Practice Address - Street 1:6073 MT MORIAH RD EXT
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2666
Practice Address - Country:US
Practice Address - Phone:901-365-2555
Practice Address - Fax:901-365-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN211432080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3896594Medicaid