Provider Demographics
NPI:1164638391
Name:KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:KENNEDY KRIEGER CHILDREN'S HOSPITAL, INC.
Other - Org Name:KENNEDY KRIEGER INSTITUTE - EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-923-1810
Mailing Address - Street 1:P.O. BOX 744865
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374
Mailing Address - Country:US
Mailing Address - Phone:443-923-1886
Mailing Address - Fax:443-923-1875
Practice Address - Street 1:707 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:443-923-9200
Practice Address - Fax:443-923-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-036332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD091678100Medicaid