Provider Demographics
NPI:1396126751
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT FINANCIAL SRVS
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIRDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-5722
Mailing Address - Street 1:PO BOX 8500-7817
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7817
Mailing Address - Country:US
Mailing Address - Phone:267-426-5722
Mailing Address - Fax:267-426-7138
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 22
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:267-426-5722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910078Medicaid
PA1007709910059Medicaid
PA0001006000OtherIBC
PA1007709910059Medicaid