CHILDREN'S MEDICAL SERVICES, INC

Provider Demographics

• NPI: 1083665137
• Name: CHILDREN'S MEDICAL SERVICES, INC
• Entity Type: Organization
• Organization Name: CHILDREN'S MEDICAL SERVICES, INC
• Authorized Official - Title/Position: SENIOR DIRECTOR, MSS
• Authorized Official - First Name: MICHELLE
• Authorized Official - Last Name: STULTZ
• Authorized Official - Credentials: RN, CPCS, CPCSM
• Authorized Official - Phone: 513-636-6977
• Mailing Address - Street 1: 3333 BURNET AVE
• Mailing Address - Street 2: ML 5021
• Mailing Address - City: CINCINNATI
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45229-3039
• Mailing Address - Country: US
• Mailing Address - Phone: 513-636-5013
• Mailing Address - Fax: 866-213-7084
• Practice Address - Street 1: 3333 BURNET AVE
• Practice Address - Street 2: ML 2001
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45229-3039
• Practice Address - Country: US
• Practice Address - Phone: 513-636-4408
• Practice Address - Fax: 513-636-7337
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-13
• Last Update Date: 2008-06-19

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207LP3000X	Allopathic & Osteopathic Physicians	Anesthesiology	Pediatric Anesthesiology	Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	364S00000X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NJ	0031704	Medicaid
VT	1012171	Medicaid
WY	123442100	Medicaid
TN	4401094	Medicaid
SC	QPA275	Medicaid
OK	200073160A	Medicaid
FL	912592200	Medicaid
KY	1172523	Other	PASSPORT
TX	168854101	Medicaid
IA	0747634	Medicaid
MS	08780896	Medicaid
PA	001888699-0001	Medicaid
NY	02800044	Medicaid
IN	200318570A	Medicaid
KS	200421920A	Medicaid
WV	0001846002	Medicaid
RI	CH93141	Medicaid
OH	2229805	Medicaid
KY	65934085	Medicaid
OH	2229805	Medicaid