1053464305 NPI number — CHMC COMMUNITY HEALTH SERVICES NETWORK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053464305 NPI number — CHMC COMMUNITY HEALTH SERVICES NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHMC COMMUNITY HEALTH SERVICES NETWORK
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:
6
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:
1053464305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BURNET AVENUE ML 5021
Provider Second Line Business Mailing Address:
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:
124 STATE ROAD 46 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47006-1487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-933-6000
Provider Business Practice Location Address Fax Number:
812-933-6013
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUTHRIE
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
DIRECTOR MEDICAL STAFF SERVICES
Authorized Official Telephone Number:
513-636-9691

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: 200122080A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0264271 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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