Provider Demographics
NPI:1700963345
Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Entity Type:Organization
Organization Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Other - Org Name:OVER THE MOUNTAIN PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-638-9901
Mailing Address - Street 1:3300 CAHABA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2623
Mailing Address - Country:US
Mailing Address - Phone:205-870-7292
Mailing Address - Fax:205-870-3639
Practice Address - Street 1:3300 CAHABA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2623
Practice Address - Country:US
Practice Address - Phone:205-870-7292
Practice Address - Fax:205-870-3639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHILDREN'S HOSPITAL OF ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529800600Medicaid
AL510F948OtherBLUE CROSS BLUE SHIELD
AL515F948OtherBLUE CROSS BLUE SHIELD
AL510F948OtherBLUE CROSS BLUE SHIELD