1366580391 NPI number — CHILDREN'S HOSPITAL MEDICAL CENTER

Table of content: (NPI 1366580391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366580391 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:
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:
1366580391
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:
3337 SOLUTIONS CENTER
Provider Second Line Business Mailing Address:
BOX 773337
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-3003
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:
660 LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45206-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-636-4225
Provider Business Practice Location Address Fax Number:
513-636-2511
Provider Enumeration Date:
02/02/2007

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: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45013133 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874893880 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582369 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0173998003 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200908880A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90272287 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2800026 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1193 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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