Provider Demographics
NPI:1215921457
Name:CHILDRENS HOSPITAL OF PHILADELPHIA
Entity type:Organization
Organization Name:CHILDRENS HOSPITAL OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIERDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-5722
Mailing Address - Street 1:3401 CIVIC CENTER BLVD
Mailing Address - Street 2:PARC BUSINESS SVCS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:267-426-5722
Mailing Address - Fax:267-426-7138
Practice Address - Street 1:34TH AND CIVIC CENTER BLVD
Practice Address - Street 2:PARC BUSINESS SVCS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:267-426-5722
Practice Address - Fax:267-426-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No282N00000XHospitalsGeneral Acute Care Hospital
No283XC2000XHospitalsRehabilitation HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910059Medicaid
PAP000851OtherCHAMPUS
PA0052815201Medicaid
PA4204301Medicaid
PA0001006000OtherIBC
PA1007709910078Medicaid
PA1007709910056Medicaid
PA01000275400Medicaid
PA393303OtherHORIZON BLUE CROSS
PA0052815202Medicaid
PA505533072OtherCIGNA
PA0001426OtherAETNA/US HEALTHCARE
PA393303OtherKEYSTONE HEALTH PLAN EAST
PA1007709910078Medicaid
PA1007709910056Medicaid