1720171945 NPI number — CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC

Table of content: (NPI 1720171945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720171945 NPI number — CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS 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:
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:
1720171945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 CHILDRENS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23507-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-668-7017
Provider Business Mailing Address Fax Number:
757-668-8929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 CHILDRENS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23507-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-668-7017
Provider Business Practice Location Address Fax Number:
757-668-8929
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABSHIRE
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR VP CFO
Authorized Official Telephone Number:
757-668-8565

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416A0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 236297 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009013857 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0175123000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116838 . This is a "ANTHEM TRANSPORT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 184601 . This is a "ANTHEM OYSTER POINT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 236297 . This is a "MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4900961 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0096618 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 169288 . This is a "ANTHEM REFERENCE LAB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4903301 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004930177 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000082 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004900961 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 236297 . This is a "ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000620505 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001AY . This is a "STATE OF NC TEACHERS & ST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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