Provider Demographics
NPI:1386031896
Name:CHILDREN'S COMMUNITY PRACTICES, LLC
Entity Type:Organization
Organization Name:CHILDREN'S COMMUNITY PRACTICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-722-5114
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:
Practice Address - Street 1:6051 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8218
Practice Address - Country:US
Practice Address - Phone:614-799-6044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S COMMUNITY PRACTICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0130922Medicaid