Provider Demographics
NPI:1215308614
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-425-5765
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:267-425-8500
Mailing Address - Fax:267-425-8502
Practice Address - Street 1:819 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1162
Practice Address - Country:US
Practice Address - Phone:267-425-8500
Practice Address - Fax:267-425-8502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF PHILADELPHIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-12
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910104Medicaid