Organization
QUALITY CARE FOR KIDS INDIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE RENAE STIVERS (PRESIDENT)
(502) 226-3937
Entity
Organization
Contact information
Practice address
134 N GARDNER ST, SCOTTSBURG, IN 47170-1306
(502) 226-3937
(502) 226-2929
Mailing address
100 DIAGNOSTIC DR, FRANKFORT, KY 40601-6524
(502) 226-3937
(502) 226-2929
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01023950A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01023950A
INDIANA LICENSE
IN
Enumeration date
01/20/2012
Last updated
01/20/2012
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