Healthcare Provider Details

I. General information

NPI: 1891155313
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL & MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 DODGE ST CHILDREN'S HOSPITAL & MEDICAL CENTER URGENT CARE DUNDEE
OMAHA NE
68132-3110
US

IV. Provider business mailing address

8200 DODGE ST CHILDREN'S HOSPITAL & MEDICAL CENTER
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-7650
  • Fax: 402-955-7651
Mailing address:
  • Phone: 402-955-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI KNIGHT
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 402-955-6903