Provider Demographics
NPI:1861711616
Name:HEALTHY KIDS LLC
Entity type:Organization
Organization Name:HEALTHY KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-684-2802
Mailing Address - Street 1:220 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2838
Mailing Address - Country:US
Mailing Address - Phone:931-684-2802
Mailing Address - Fax:877-671-2402
Practice Address - Street 1:220 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2838
Practice Address - Country:US
Practice Address - Phone:931-684-2802
Practice Address - Fax:877-671-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty