Provider Demographics
NPI:1700293529
Name:THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type:Organization
Organization Name:THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:COBBS CREEK FAMILY PLANNING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CORPORATE FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-6940
Mailing Address - Street 1:225 S COBBS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3723
Mailing Address - Country:US
Mailing Address - Phone:215-476-2223
Mailing Address - Fax:215-476-3981
Practice Address - Street 1:225 S COBBS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3723
Practice Address - Country:US
Practice Address - Phone:215-476-2223
Practice Address - Fax:215-476-3981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910082Medicaid