Provider Demographics
NPI:1144280116
Name:CHILDS, ED W (MD)
Entity type:Individual
Prefix:DR
First Name:ED
Middle Name:W
Last Name:CHILDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-273-7700
Mailing Address - Fax:479-464-7734
Practice Address - Street 1:1001 S HORSEBARN RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8184
Practice Address - Country:US
Practice Address - Phone:479-273-7700
Practice Address - Fax:479-464-7734
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7963208600000X
GA067203208600000X
ARE-19369208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121550BMedicaid
TX020048105OtherRR/MEDICARE
TX0457251-02OtherCSHCN
TX0457251-01Medicaid
TX8A6942OtherBLUE SHIELD
TX8771K7Medicare ID - Type Unspecified
TX020048105OtherRR/MEDICARE