Provider Demographics
NPI:1649485848
Name:CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMANCUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-543-8171
Mailing Address - Street 1:ONE PERKINS SQUARE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1062
Mailing Address - Country:US
Mailing Address - Phone:330-543-5000
Mailing Address - Fax:330-543-3084
Practice Address - Street 1:185 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2400
Practice Address - Country:US
Practice Address - Phone:330-543-5000
Practice Address - Fax:330-543-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER 23177332B00000X
333600000X
OH02-0562700251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1649485848OtherMEDICARE - INFUSION DME, NPI
OHHMER23177OtherOHIO BOARD OF PHARMACY
OH0470138Medicaid
OH1649485848OtherMEDICARE - INFUSION DME, NPI
OH0882273Medicaid
OH0882273Medicaid