1821185398 NPI number — CHILDREN'S HEALTH CENTER OF COLUMBUS, INC.

Table of content: (NPI 1821185398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821185398 NPI number — CHILDREN'S HEALTH CENTER OF COLUMBUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEALTH CENTER OF COLUMBUS, 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:
CHILDREN'S HEALTH CENTER
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:
1821185398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 N LEHMBERG ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-329-2955
Provider Business Mailing Address Fax Number:
662-370-1236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 N LEHMBERG ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-329-2955
Provider Business Practice Location Address Fax Number:
662-370-1236
Provider Enumeration Date:
10/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCDOW
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-329-2955

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09014205 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529904270 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".