Provider Demographics
NPI:1205687217
Name:KID GLOVES SURGICAL SPECIALISTS, PLLC
Entity type:Organization
Organization Name:KID GLOVES SURGICAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCVAY GILLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-349-3182
Mailing Address - Street 1:PO BOX 6908
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72766-6908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3623 JOHNSON MILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6412
Practice Address - Country:US
Practice Address - Phone:501-349-3182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty