| Forever Kids Pediatric Clinic | |
|
20783 Interstate 20 South Access Road Canton TX 75103 | |
| (214) 773-5669 | |
| (844) 678-6258 |
| Full Name | Forever Kids Pediatric Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 20783 Interstate 20 South Access Road, Canton, Texas |
| Authorized Official Name and Position | Lacy Dawn Burkes (PEDIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 2147735669 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forever Kids Pediatric Clinic 20783 Interstate 20 South Access Road Canton TX 75103 Ph: (903) 567-5437 | Forever Kids Pediatric Clinic 20783 Interstate 20 South Access Road Canton TX 75103 Ph: (214) 773-5669 |
| NPI Number | 1326435199 |
|---|---|
| Provider Enumeration Date | 04/20/2015 |
| Last Update Date | 01/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326435199 | NPI | - | NPPES |
| 1349815603 | Medicaid | TX | |
| 1750646279 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 754047 (Texas) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
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