1083665137 NPI number — CHILDREN'S MEDICAL SERVICES, INC

Table of content: (NPI 1083665137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083665137 NPI number — CHILDREN'S MEDICAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S MEDICAL SERVICES, 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:
1083665137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BURNET AVE
Provider Second Line Business Mailing Address:
ML 5021
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45229-3039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-636-5013
Provider Business Mailing Address Fax Number:
866-213-7084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 BURNET AVE
Provider Second Line Business Practice Location Address:
ML 2001
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:
513-636-4408
Provider Business Practice Location Address Fax Number:
513-636-7337
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STULTZ
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR, MSS
Authorized Official Telephone Number:
513-636-6977

Provider Taxonomy Codes

  • Taxonomy code: 207LP3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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" .

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

  • Identifier: 0031704 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012171 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123442100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4401094 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: QPA275 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200073160A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 912592200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1172523 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 168854101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0747634 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08780896 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001888699-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02800044 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200318570A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200421920A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001846002 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH93141 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2229805 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65934085 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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