Provider Demographics
NPI:1548438849
Name:KIDHEALTH, LLC
Entity type:Organization
Organization Name:KIDHEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATERFIEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-812-0168
Mailing Address - Street 1:PO BOX 2673
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2673
Mailing Address - Country:US
Mailing Address - Phone:318-812-0168
Mailing Address - Fax:318-812-0170
Practice Address - Street 1:5000 FORSYTHE BYP
Practice Address - Street 2:SUITE 2
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2168
Practice Address - Country:US
Practice Address - Phone:318-812-0168
Practice Address - Fax:318-812-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306703OtherMEDICAID KM