Provider Demographics
NPI:1124105762
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:205-638-9901
Mailing Address - Street 1:5295 PRESERVE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4702
Mailing Address - Country:US
Mailing Address - Phone:205-987-4444
Mailing Address - Fax:205-987-4451
Practice Address - Street 1:5295 PRESERVE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4702
Practice Address - Country:US
Practice Address - Phone:205-987-4444
Practice Address - Fax:205-987-4451
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:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515F980OtherBLUE CROSS BLUE SHIELD
AL529602520Medicaid
AL510F980OtherBLUE CROSS BLUE SHIELD
AL529602520Medicaid
AL=========011OtherTRICARE
AL=========010OtherTRICARE
AL=========031OtherTRICARE
AL=========112OtherTRICARE