Provider Demographics
| NPI: | 1609915784 |
|---|---|
| Name: | CHILDREN'S HOSPITAL MEDICAL CENTER |
| Entity type: | Organization |
| Organization Name: | CHILDREN'S HOSPITAL MEDICAL CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | SR. DIRECTOR MEDICAL STAFF SERVICES |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KIMBERLY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GIVENS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 513-636-6977 |
| Mailing Address - Street 1: | 3333 BURNET AVENUE |
| Mailing Address - Street 2: | MAIL LOCATION 5021 |
| Mailing Address - City: | CINCINNATI |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45229-3026 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 513-636-4225 |
| Mailing Address - Fax: | 513-636-2511 |
| Practice Address - Street 1: | 3333 BURNET AVENUE |
| Practice Address - Street 2: | |
| Practice Address - City: | CINCINNATI |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45229-3039 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 513-636-4225 |
| Practice Address - Fax: | 513-636-2511 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | CHILDREN'S HOSPITAL MEDICAL CENTER |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-02-06 |
| Last Update Date: | 2024-07-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 152WP0200X | Eye and Vision Services Providers | Optometrist | Pediatrics | Group - Multi-Specialty |
| No | 207LP3000X | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WV | 0001846001 | Medicaid | |
| PA | 001065780-0005 | Medicaid | |
| WY | 117749401 | Medicaid | |
| TX | 119659404 | Medicaid | |
| OK | 100690580B | Medicaid | |
| FL | 108749800 | Medicaid | |
| NJ | 8674809 | Medicaid | |
| CO | 65823524 | Medicaid | |
| OH | 0307822 | Medicaid | |
| KS | 100280240C | Medicaid | |
| KY | 77903474 | Medicaid | |
| KY | 78904349 | Medicaid | |
| KY | 95901138 | Medicaid | |
| SC | QPA814 | Medicaid | |
| PA | 001065780-0006 | Medicaid | |
| IA | 0738674 | Medicaid | |
| IN | 100012670A | Medicaid | |
| KY | 1172363 | Other | PASSPORT (NEONATAL) |
| NY | 02757106 | Medicaid | |
| KY | 1172052 | Other | PASSPORT |
| KY | 65901886 | Medicaid | |
| KY | 77903474 | Medicaid |
