Provider Demographics
NPI:1073798146
Name:THE CHILDREN'S HEALTH CENTER
Entity Type:Organization
Organization Name:THE CHILDREN'S HEALTH CENTER
Other - Org Name:CHRISTOPHER TALLO, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:TALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-490-8022
Mailing Address - Street 1:2510 EAST DUPONT ROAD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-490-8022
Mailing Address - Fax:260-490-8035
Practice Address - Street 1:2510 EAST DUPONT ROAD
Practice Address - Street 2:SUITE 236
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-490-8022
Practice Address - Fax:260-490-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0144949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty