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Contact Information

KENNETH CHILDERS P A
611 S MT OLIVE
SILOAM SPRINGS, AR72761
 Phone: 479-524-4231
 Fax: 479-524-8850
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for KENNETH CHILDERS P A

NPI Number 1407069487
LBN Legal business name KENNETH CHILDERS P A
Authorized official KENNETH CHILDERS - (OPTOMETRIST)
Entity Organization
Organization subpart 1 No
Enumeration date 05/07/2007
Last updated 10/08/2008 - About 18 years ago
Identifiers
AR License # 2039
AR Medicaid 139158722
AR Other 5G041 MEDICARE GROUP PTAN
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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