=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700982592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S HOSPITAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 BICKFORD ST
-----------------------------------------------------
City | JAMAICA PLAIN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02130-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-355-4831
-----------------------------------------------------
Fax | 617-730-0080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 LONGWOOD AVE PATIENT FINANCIAL SERVICES ATN STEVEN NICOLL
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02115-5724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-355-4831
-----------------------------------------------------
Fax | 617-730-0080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP FINANCE AND CFO
-----------------------------------------------------
Name | MR. DAVID A KIRSHNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-355-6881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number | 2139
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------