Organization
KIDS KLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AHMAD HAIDAR MD (OWNER)
(601) 799-4777
Entity
Organization
Contact information
Practice address
200 COUNTRY CLUB RD, CARRIERE, MS 39426-9037
(601) 799-4777
Mailing address
200 COUNTRY CLUB RD, CARRIERE, MS 39426-9037
(601) 799-4777
(601) 749-8818
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
13678
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112453
—
MS
Enumeration date
02/21/2013
Last updated
12/03/2015
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