Provider Demographics
NPI:1720845894
Name:CHILDRENS MEDICAL CENTER
Entity type:Organization
Organization Name:CHILDRENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LABORATORY SCIENTISTS
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LL
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MLS
Authorized Official - Phone:256-810-1085
Mailing Address - Street 1:1230 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-3602
Mailing Address - Country:US
Mailing Address - Phone:256-810-1085
Mailing Address - Fax:
Practice Address - Street 1:1230 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-3602
Practice Address - Country:US
Practice Address - Phone:256-810-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center