Provider Demographics
NPI:1477643690
Name:TEXAS CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:TEXAS CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:WELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-828-3660
Mailing Address - Street 1:2450 HOLCOMBE BLVD
Mailing Address - Street 2:JP MCGOVERN BLDG 22G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2039
Mailing Address - Country:US
Mailing Address - Phone:832-824-6809
Mailing Address - Fax:832-825-2184
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC0050X, 261QE0700X, 281PC2000X, 341600000X, 343800000X
TX000117282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No281PC2000XHospitalsChronic Disease HospitalChildren
No341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139135102Medicaid
TX139135116Medicaid
TX139135105Medicaid
TX139135106Medicaid
TX139135118Medicaid
TXHH0222OtherBCBS
TX139135112Medicaid
TX139135120Medicaid
TX139135108Medicaid
TX139135109Medicaid
TX139135117Medicaid
TX139135118Medicaid
TX139135105Medicaid