Provider Demographics
NPI:1861658205
Name:DRISCOLL CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:DRISCOLL CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:HAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-694-4602
Mailing Address - Street 1:3533 S. ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-694-5000
Mailing Address - Fax:361-808-2089
Practice Address - Street 1:3533 S. ALAMEDA
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1721
Practice Address - Country:US
Practice Address - Phone:361-694-5000
Practice Address - Fax:361-808-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008106261QE0700X
TX110249261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132812208OtherESRD -TRADITIONAL MEDICAID
TX1689067910Medicaid
TX132812209OtherESRD -MEDICAID CSHCN
TX1689067910Medicaid