1619075926 NPI number — KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.

Table of content: (NPI 1619075926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619075926 NPI number — KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEDY KRIEGER CHILDREN'S HOSPITAL, 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:
KENNEDY KRIEGER INSTITUTE
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 Information

NPI Number:
1619075926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45944
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-5944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-923-1886
Provider Business Mailing Address Fax Number:
443-923-1875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 N BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21205-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-923-1870
Provider Business Practice Location Address Fax Number:
443-923-9405
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BADIE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
AVP, APPLICATION SUPPORT
Authorized Official Telephone Number:
443-923-1812

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X , with the licence number:  30036 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 281PC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282E00000X , with the licence number: 30-036 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283XC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 284300000X , with the licence number: 30-036 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 802 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 955675300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD9 . This is a "BLUE CROSS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 59351301 . This is a "BLUE CROSS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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