1477643690 NPI number — TEXAS CHILDREN'S HOSPITAL

Table of content: (NPI 1477643690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477643690 NPI number — TEXAS CHILDREN'S HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS CHILDREN'S HOSPITAL
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:
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:
1477643690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 HOLCOMBE BLVD
Provider Second Line Business Mailing Address:
JP MCGOVERN BLDG 22G
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77021-2039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-824-6809
Provider Business Mailing Address Fax Number:
832-825-2184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6621 FANNIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-824-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAGE
Authorized Official First Name:
WELDON
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT/CFO
Authorized Official Telephone Number:
832-828-3660

Provider Taxonomy Codes

  • Taxonomy code: 261QC0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 281PC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC2000X , with the licence number: 000117 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 139135102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135116 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135118 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0222 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 139135112 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135120 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135108 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135109 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139135117 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108974000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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