Provider Demographics
NPI:1558467977
Name:CHILDREN'S HOSPITAL AMBULANCE AN INC DIV OF THE CHILDRENS HOSP CORP
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL AMBULANCE AN INC DIV OF THE CHILDRENS HOSP CORP
Other - Org Name:CHILDREN'S HOSPITAL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHURCHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-355-7272
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6000
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5737
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA820709OtherTUFTS AMBULANCE
MAS009072OtherTRICARE AMBULANCE
MA31524OtherNHP AMBULANCE
MA108059OtherBLUE CROSS AMB
MA1200445Medicaid
MA27725OtherBMC AMBULANCE
MAAA47863OtherHP AMBULANCE
MA108059OtherBLUE CROSS AMB
MA820709OtherTUFTS AMBULANCE