Provider Demographics
NPI:1104903749
Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Entity type:Organization
Organization Name:THE CHILDREN'S HOSPITAL OF ALABAMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:205-638-9073
Mailing Address - Street 1:2001 OLD WARRIOR RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-1890
Mailing Address - Country:US
Mailing Address - Phone:205-481-1886
Mailing Address - Fax:205-638-5570
Practice Address - Street 1:2001 OLD WARRIOR RIVER RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1890
Practice Address - Country:US
Practice Address - Phone:205-481-1886
Practice Address - Fax:205-638-5570
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:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515F957OtherBLUE CROSS BLUE SHIELD
AL529907110Medicaid
AL515F957OtherBLUE CROSS BLUE SHIELD