Provider Demographics
NPI:1710087127
Name:CHILDREN'S HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL CORPORATION
Other - Org Name:BOSTON CHILDREN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
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:02115-5724
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:2006-09-25
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QD0000X, 282N00000X
MA2139261QA1903X, 261QE0700X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2222012210OtherBLUE CROSS OUTPATIENT
MA0007052OtherNEIGHBORHOOD HEALTH PLN
MA2222012201OtherBLUE CROSS INPATIENT
MA699031OtherTUFTS HOSP CLINIC MD'S
MA0006817OtherNHP-CHPCC
MA110026858AMedicaid
MA110026858CMedicaid
MA643120OtherTUFTS HOSP RADIOLOGISTS
MA6561OtherBOSTON MEDICAL CENTER
MA900018OtherHARVARD PILGRIM HEALTH P
MA900035OtherTUFTS OUTPATIENT
MA0006795OtherNHP-MEHC
MA458829052OtherCIGNA
MA0006818OtherNHP- ADOLESCENT
MA6300175OtherAETNA
MA903904OtherTUFTS INPATIENT
MA110026858BMedicaid
MA2222012230OtherBLUE CROSS DSU/OBSV
MA0006795OtherNHP-MEHC
MA0006795OtherNHP-MEHC
MA2222012201OtherBLUE CROSS INPATIENT