Organization
KIDSCARE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ANDREW JORDAN M.D. (OWNER)
(615) 453-1252
Entity
Organization
Contact information
Practice address
1029 W MAIN ST, SUITE O, LEBANON, TN 37087-3351
(615) 453-1252
Mailing address
1029 W MAIN ST, SUITE M, LEBANON, TN 37087-3351
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/17/2012
Last updated
09/17/2012
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