Healthcare Provider Details

I. General information

NPI: 1346297843
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL & MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 10/02/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number260005
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number5116
License Number StateNE

VIII. Authorized Official

Name: CHANDA C CHACON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 402-955-4106