Provider Demographics
NPI:1720171945
Name:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Entity Type:Organization
Organization Name:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-668-8565
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7017
Mailing Address - Fax:757-668-8929
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7017
Practice Address - Fax:757-668-8929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000620505Medicaid
VA000082OtherANTHEM BC BS
VA0096618OtherAETNA
VA116838OtherANTHEM TRANSPORT
VA236297OtherOPTIMUM CHOICE
VA004900961Medicaid
VA009013857Medicaid
NC4903301Medicaid
WV0175123000Medicaid
VA169288OtherANTHEM REFERENCE LAB
VA184601OtherANTHEM OYSTER POINT
VA236297OtherALLIANCE
VA004930177Medicaid
VA236297OtherMDIPA
VA4900961OtherVIRGINIA PREMIER
NC001AYOtherSTATE OF NC TEACHERS & ST
VA236297OtherALLIANCE
VA=========OtherOPTIMA/SENTARA
NC4903301Medicaid
DE0000620505Medicaid