1720171945 NPI number — CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720171945 NPI number — CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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 Information

NPI Number:
1720171945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 CHILDRENS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23507-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-668-7017
Provider Business Mailing Address Fax Number:
757-668-8929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 CHILDRENS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23507-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-668-7017
Provider Business Practice Location Address Fax Number:
757-668-8929
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RYAN
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
SENIOR VP/CFO
Authorized Official Telephone Number:
757-668-8565

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416A0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000620505 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000082 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0096618 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 116838 . This is a "ANTHEM TRANSPORT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 236297 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004900961 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009013857 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4903301 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0175123000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169288 . This is a "ANTHEM REFERENCE LAB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 184601 . This is a "ANTHEM OYSTER POINT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 236297 . This is a "ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004930177 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 236297 . This is a "MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4900961 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 001AY . This is a "STATE OF NC TEACHERS & ST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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