1609915784 NPI number — CHILDREN'S HOSPITAL MEDICAL CENTER

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609915784 NPI number — CHILDREN'S HOSPITAL MEDICAL CENTER

Employer Identification Number (EIN):

Provider Organization Name:

CHILDREN'S HOSPITAL MEDICAL CENTER

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1609915784

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/19/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3333 BURNET AVENUE

Provider Second Line Business Mailing Address:

MAIL LOCATION 5021

Provider Business Mailing Address City Name:

CINCINNATI

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

45229-3026

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

513-636-4225

Provider Business Mailing Address Fax Number:

513-636-2511

Provider First Line Business Practice Location Address:

3333 BURNET AVENUE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CINCINNATI

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

45229-3039

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

513-636-4225

Provider Business Practice Location Address Fax Number:

513-636-2511

Provider Enumeration Date:

02/06/2007

Authorized Official Last Name:

GIVENS

Authorized Official First Name:

KIMBERLY

Authorized Official Middle Name:

Authorized Official Title or Position:

SR. DIRECTOR MEDICAL STAFF SERVICES

Authorized Official Telephone Number:

513-636-6977

• Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 152WP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LP3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 364S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 100280240C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 108749800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 0001846001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 100012670A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 001065780-0006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0307822 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 117749401 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 65823524 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 95901138 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: QPA814 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 0738674 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 100690580B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: 8674809 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 1172363 . This is a "PASSPORT (NEONATAL)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 119659404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 65901886 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 78904349 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 001065780-0005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 02757106 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 1172052 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".