Provider Demographics
NPI:1295729747
Name:THE CHILDHEALTH CENTER, PA
Entity type:Organization
Organization Name:THE CHILDHEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:V
Authorized Official - Last Name:SUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-322-4453
Mailing Address - Street 1:1455 25TH AVE DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601
Mailing Address - Country:US
Mailing Address - Phone:828-322-4453
Mailing Address - Fax:828-324-9295
Practice Address - Street 1:1455 25TH AVE DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-322-4453
Practice Address - Fax:828-324-9295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty