Childress, Jack R
Childress, Jack R is an individual health care provider with primary practice located at 105 Sequoya Dr , Lake Kiowa TX 76240-9446. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Childress, Jack R can be contacted via phone (940) 736-8885.Contact Information
Primary practice address
105 Sequoya Dr
Lake Kiowa TX 76240-9446
Phone: (940) 736-8885
Fax: (940) 668-8292
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | H5535 | Texas |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | H5535 | Texas |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 14502A | Wyoming |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 97208 | Georgia |
Profile Details
| NPI number | 1841245883 |
|---|---|
| LBN Legal business name | Childress, Jack R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 24th, 2006 |
| Last updated | Dec 29th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841245883 | NPPES |
| Texas | Other | 8V4246 | BCBS-TEXAS |
| Texas | MEDICAID | 163713001 | BCBS-TEXAS |
| Texas | MEDICAID | 1140766-07 | BCBS-TEXAS |
| Texas | Other | 84487 | BCBS-TEXAS |
| Texas | Other | P00466537 | BCBS-TEXAS |
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