Organization
HENDERSON PEDIATRICS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY K RUDD (BILLING SPECIALIST)
(270) 827-4596
Entity
Organization
Contact information
Practice address
1035 N ELM ST, HENDERSON, KY 42420-2712
(270) 827-4596
Mailing address
1035 N ELM ST, HENDERSON, KY 42420-2712
(270) 827-4596
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
40961
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000625514
ANTHEM
KY
05
—
7100005530
—
KY
Enumeration date
09/14/2009
Last updated
09/14/2009
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