Healthcare Provider Details

I. General information

NPI: 1366580391
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 LINCOLN AVE
CINCINNATI OH
45206-1100
US

IV. Provider business mailing address

3337 SOLUTIONS CENTER BOX 773337
CHICAGO IL
60677-3003
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4225
  • Fax: 513-636-2511
Mailing address:
  • Phone: 513-636-4225
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JODIANNE BROOMALL
Title or Position: SR DIRECTOR BILLING & CODING SERV
Credential:
Phone: 513-636-5047