CHILDREN'S HOSPITAL MEDICAL CENTER

Provider Demographics

• NPI: 1609915784
• Name: CHILDREN'S HOSPITAL MEDICAL CENTER
• Entity Type: Organization
• Organization Name: CHILDREN'S HOSPITAL MEDICAL CENTER
• Other - Org Name: CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: SR. DIRECTOR MEDICAL STAFF SERVICES
• Authorized Official - First Name: KIMBERLY
• Authorized Official - Last Name: GIVENS
• Authorized Official - Phone: 513-636-6977
• Mailing Address - Street 1: 3333 BURNET AVENUE
• Mailing Address - Street 2: MAIL LOCATION 5021
• Mailing Address - City: CINCINNATI
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45229-3026
• Mailing Address - Country: US
• Mailing Address - Phone: 513-636-4225
• Mailing Address - Fax: 513-636-2511
• Practice Address - Street 1: 3333 BURNET AVENUE
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45229-3039
• Practice Address - Country: US
• Practice Address - Phone: 513-636-4225
• Practice Address - Fax: 513-636-2511
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: CHILDREN'S HOSPITAL MEDICAL CENTER
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2007-02-06
• Last Update Date: 2024-03-19

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Multi-Specialty
No	103G00000X	Behavioral Health & Social Service Providers	Clinical Neuropsychologist		Group - Multi-Specialty
No	103K00000X	Behavioral Health & Social Service Providers	Behavior Analyst		Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	152WP0200X	Eye and Vision Services Providers	Optometrist	Pediatrics	Group - Multi-Specialty
No	207LP3000X	Allopathic & Osteopathic Physicians	Anesthesiology	Pediatric Anesthesiology	Group - Multi-Specialty
No	2251S0007X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist	Sports	Group - Multi-Specialty
No	231H00000X	Speech, Language and Hearing Service Providers	Audiologist		Group - Multi-Specialty
No	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	364S00000X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KS	100280240C	Medicaid
FL	108749800	Medicaid
WV	0001846001	Medicaid
IN	100012670A	Medicaid
PA	001065780-0006	Medicaid
OH	0307822	Medicaid
WY	117749401	Medicaid
CO	65823524	Medicaid
KY	95901138	Medicaid
SC	QPA814	Medicaid
IA	0738674	Medicaid
OK	100690580B	Medicaid
NJ	8674809	Medicaid
KY	1172363	Other	PASSPORT (NEONATAL)
TX	119659404	Medicaid
KY	65901886	Medicaid
KY	78904349	Medicaid
PA	001065780-0005	Medicaid
NY	02757106	Medicaid
KY	1172052	Other	PASSPORT
KY	77903474	Medicaid
KY	77903474	Medicaid