Provider Demographics
NPI:1760589873
Name:KID CARE, PSC
Entity Type:Organization
Organization Name:KID CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-759-5437
Mailing Address - Street 1:991 MEDICAL PARK DR STE 107
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8766
Mailing Address - Country:US
Mailing Address - Phone:606-759-5437
Mailing Address - Fax:606-759-9267
Practice Address - Street 1:991 MEDICAL PARK DR STE 107
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8766
Practice Address - Country:US
Practice Address - Phone:606-759-5437
Practice Address - Fax:606-759-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65900797Medicaid