Healthcare Provider Details

I. General information

NPI: 1346388378
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: 03/07/2023
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE
CINCINNATI OH
45229-3039
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02-0040400
License Number StateOH

VIII. Authorized Official

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