Provider Demographics
NPI:1437171568
Name:METHODIST CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:METHODIST CHILDREN'S HOSPITAL
Other - Org Name:COVENANT CHILDREN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY FOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-951-7477
Mailing Address - Street 1:PO BOX 677044
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-7044
Mailing Address - Country:US
Mailing Address - Phone:806-725-6967
Mailing Address - Fax:806-725-5356
Practice Address - Street 1:4015 22ND PLACE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103188100Medicaid
TX1273195-02Medicaid
NMA9467OtherACUTE
TX1273195-04Medicaid
TX133478106OtherCSCHN/ACUTE
103171100OtherFIRSTCARE COMMERCIAL
NM201075601Medicaid
TXHH1177OtherBLUE CROSS TEXAS
TX127319503OtherCSCHN/ DAY SURGERY
TX127319503OtherCSCHN/ DAY SURGERY