Provider Demographics
NPI:1154469930
Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Other - Org Name:CHILDREN'S HOSPITAL MEDICAL CENTER - STARSHINE HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:SR DIRECTOR BILLING & CODING SERV
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-636-5047
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:MAIL LOCATION 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4225
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:660 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1100
Practice Address - Country:US
Practice Address - Phone:513-636-4225
Practice Address - Fax:513-636-2511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2054306Medicaid
OH2054306Medicaid