CHILDREN'S HOSPITAL MEDICAL CENTER

Provider Demographics

• NPI: 1548212988
• Name: CHILDREN'S HOSPITAL MEDICAL CENTER
• Entity Type: Organization
• Organization Name: CHILDREN'S HOSPITAL MEDICAL CENTER
• Authorized Official - Title/Position: SR DIRECTOR BILLING & CODING SERV
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: JODIANNE
• Authorized Official - Last Name: BROOMALL
• Authorized Official - Phone: 513-636-5047
• Mailing Address - Street 1: 3333 BURNET AVE
• Mailing Address - Street 2: ML 9013
• 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: 3333 BURNET AVE
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45229
• Practice Address - Country: US
• Practice Address - Phone: 513-636-4225
• Practice Address - Fax: 513-636-2511
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-16
• Last Update Date: 2022-05-18

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282NC2000X	Hospitals	General Acute Care Hospital	Children
No	261QP2300X	Ambulatory Health Care Facilities	Clinic/Center	Primary Care
No	291U00000X	Laboratories	Clinical Medical Laboratory
No	332BD1200X	Suppliers	Durable Medical Equipment & Medical Supplies	Dialysis Equipment & Supplies
No	3416A0800X	Transportation Services	Ambulance	Air Transport
No	3416L0300X	Transportation Services	Ambulance	Land Transport

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	01540871	Medicaid
KY	55000152	Medicaid
PA	001065780-0001	Medicaid
OH	1473285	Medicaid
KY	56014228	Medicaid
SC	10198A	Medicaid
IN	200260070A	Medicaid
MI	404488860	Medicaid
NJ	4183703	Medicaid
KY	700093	Medicaid
MI	304488850	Medicaid
WV	0173998000	Medicaid
SC	10454B	Medicaid
FL	107519900	Medicaid
KY	1640	Medicaid
NY	01100527	Medicaid
TX	119659401	Medicaid
KY	31000425	Medicaid
MI	304488850	Medicaid
KY	31000425	Medicaid