Provider Demographics
NPI:1679980528
Name:THE CHILDREN'S HOSPITAL OF PHILADLEPHIA
Entity type:Organization
Organization Name:THE CHILDREN'S HOSPITAL OF PHILADLEPHIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:267-426-6179
Mailing Address - Street 1:4865 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3508
Mailing Address - Country:US
Mailing Address - Phone:267-425-9800
Mailing Address - Fax:267-425-9999
Practice Address - Street 1:4865 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3508
Practice Address - Country:US
Practice Address - Phone:267-425-9800
Practice Address - Fax:267-425-9999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHILDREN'S HOSPITAL OF PHILADLEPHIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-11
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910071Medicaid