Provider Demographics
NPI:1205989621
Name:ABC CHILDREN'S HEALTH CENTER
Entity type:Organization
Organization Name:ABC CHILDREN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-886-8677
Mailing Address - Street 1:91 TINKLING SPRING DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2303
Mailing Address - Country:US
Mailing Address - Phone:540-886-8677
Mailing Address - Fax:540-886-8678
Practice Address - Street 1:91 TINKLING SPRING DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2303
Practice Address - Country:US
Practice Address - Phone:540-886-8677
Practice Address - Fax:540-886-8678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF76886Medicare UPIN