Provider Demographics
NPI:1467621045
Name:CHILD STUDY CENTER
Entity Type:Organization
Organization Name:CHILD STUDY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-885-4480
Mailing Address - Street 1:1300 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3410
Mailing Address - Country:US
Mailing Address - Phone:817-390-2904
Mailing Address - Fax:817-390-2901
Practice Address - Street 1:1300 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3410
Practice Address - Country:US
Practice Address - Phone:817-390-2904
Practice Address - Fax:817-390-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091294102Medicaid
TX189125101Medicaid