Provider Demographics
NPI:1033554910
Name:NATIONWIDE CHILDREN'S HIOSPITAL
Entity Type:Organization
Organization Name:NATIONWIDE CHILDREN'S HIOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUCHUROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:614-355-6020
Mailing Address - Street 1:5680 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2190
Mailing Address - Country:US
Mailing Address - Phone:614-355-8737
Mailing Address - Fax:614-355-8710
Practice Address - Street 1:5680 VENTURE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2190
Practice Address - Country:US
Practice Address - Phone:614-355-8737
Practice Address - Fax:614-355-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-001784261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation