Provider Demographics
NPI:1720257645
Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Entity Type:Organization
Organization Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Other - Org Name:DENTAL CLINIC - CHS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:205-638-9901
Mailing Address - Street 1:PO BOX 114070536
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0536
Mailing Address - Country:US
Mailing Address - Phone:205-638-5600
Mailing Address - Fax:205-638-5623
Practice Address - Street 1:1600 7TH AVE S # CLINIC9
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9161
Practice Address - Fax:205-638-9796
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHILDREN'S HOSPITAL OF ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH3704261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529918130Medicaid