Provider Demographics
NPI: | 1952480030 |
---|---|
Name: | DAYTON CHILDREN'S HOSPITAL |
Entity Type: | Organization |
Organization Name: | DAYTON CHILDREN'S HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | C.F.O. |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CHRIS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BERGMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CFO |
Authorized Official - Phone: | 937-641-3338 |
Mailing Address - Street 1: | PO BOX 933421 |
Mailing Address - Street 2: | |
Mailing Address - City: | CLEVELAND |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44193-0039 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-641-5072 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 CHILDRENS PLZ |
Practice Address - Street 2: | |
Practice Address - City: | DAYTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45404-1815 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-641-3401 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | DAYTON CHILDREN'S HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-11-02 |
Last Update Date: | 2024-01-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
Yes | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 2080S0012X | Allopathic & Osteopathic Physicians | Pediatrics | Sleep Medicine | Group - Single Specialty |
No | 2088P0231X | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | .0324474 | Medicaid | |
H198500 | Other | MEDICARE |