Provider Demographics
NPI:1629161112
Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Entity Type:Organization
Organization Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Other - Org Name:PEDIATRIC ENT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-638-9901
Mailing Address - Street 1:1940 ELMER J BISSELL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2941
Mailing Address - Country:US
Mailing Address - Phone:205-824-4949
Mailing Address - Fax:
Practice Address - Street 1:1940 ELMER J. BISSELL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-824-4949
Practice Address - Fax:205-824-4983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHILDREN'S HOSPITAL OF ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529903800Medicaid
AL529903810Medicaid
AL510F950OtherBLUECROSS BLUE SHEILD
AL515F950OtherBLUE CROSS BLUE SHEILD AL