1720166085 NPI number — THE CHILDREN'S HOSPITAL OF ALABAMA

Table of content: (NPI 1720166085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720166085 NPI number — THE CHILDREN'S HOSPITAL OF ALABAMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHILDREN'S HOSPITAL OF ALABAMA
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 HOSPITAL DIALYSIS
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:
1720166085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 114070536
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-0536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-638-5600
Provider Business Mailing Address Fax Number:
205-385-6236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 7TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-638-9100
Provider Business Practice Location Address Fax Number:
205-638-9189
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTON
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
205-638-9901

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  12051 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DIA3300D , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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