Provider Demographics
NPI:1861380560
Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-636-5047
Mailing Address - Street 1:3337 SOLUTIONS CTR # 773337
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3003
Mailing Address - Country:US
Mailing Address - Phone:513-636-4170
Mailing Address - Fax:
Practice Address - Street 1:4315 IVY POINTE BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1767
Practice Address - Country:US
Practice Address - Phone:513-636-0030
Practice Address - Fax:513-517-5200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy