1386025039 NPI number — CHILDREN'S HOSPITAL MEDICAL CENTER

Table of content: (NPI 1386025039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386025039 NPI number — CHILDREN'S HOSPITAL MEDICAL CENTER

Organization/Personal Information

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's Other Name Information

Provider Other Organization Name:
CINCINNATI CHILDREN'S LIBERTY CAMPUS
Provider Other Organization Name Type Code:
5
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:
1386025039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2020
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:
MLC 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's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 YANKEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY TOWNSHIP
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45044-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-803-9600
Provider Business Practice Location Address Fax Number:
513-636-2511
Provider Enumeration Date:
06/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BROOMALL
Authorized Official First Name:
JODIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
SR DIRECTOR BILLING & CODING SERV
Authorized Official Telephone Number:
513-636-5047

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  02-2514850 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1473285 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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