Healthcare Provider Details

I. General information

NPI: 1386025039
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 YANKEE RD
LIBERTY TOWNSHIP OH
45044-3500
US

IV. Provider business mailing address

3333 BURNET AVE MLC 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-9600
  • 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 Number02-2514850
License Number StateOH

VIII. Authorized Official

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