Provider Demographics
NPI:1407026297
Name:FIX KIDS, INCORPORATED
Entity Type:Organization
Organization Name:FIX KIDS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-274-2711
Mailing Address - Street 1:2507 BATTLEGROUND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4003
Mailing Address - Country:US
Mailing Address - Phone:336-274-2711
Mailing Address - Fax:
Practice Address - Street 1:2507 BATTLEGROUND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4003
Practice Address - Country:US
Practice Address - Phone:336-274-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26011261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0152BOtherBCBS
NC890152BMedicaid
NC890152BMedicaid
NC0152BOtherBCBS