1700982592 NPI number — CHILDREN'S HOSPITAL CORPORATION

Table of content: (NPI 1700982592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700982592 NPI number — CHILDREN'S HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HOSPITAL CORPORATION
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:
CHILDRE'S HOSPITAL BOSTON EARLY INTERVENTION PROGRAM
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:
1700982592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 LONGWOOD AVE
Provider Second Line Business Mailing Address:
PATIENT FINANCIAL SERVICES ATN STEVEN NICOLL
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-355-4831
Provider Business Mailing Address Fax Number:
617-730-0080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 BICKFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-355-4831
Provider Business Practice Location Address Fax Number:
617-730-0080
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIRSHNER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SR VP FINANCE AND CFO
Authorized Official Telephone Number:
617-355-6881

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  2139 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: E10038 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 613436 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 623879 . This is a "HARVARD PILGRIM HEALTH PL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000006560 . This is a "BOSTON MEDICAL CTR HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0009150 . This is a "NEIGHBORHOOD HELATH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1803212 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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