Basic Information
| Provider Information | |||||||||
| NPI: | 1477643690 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 HOLCOMBE BLVD | ||||||||
| Address2: | JP MCGOVERN BLDG 22G | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770212039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328246809 | ||||||||
| FaxNumber: | 8328252184 | ||||||||
| Practice Location | |||||||||
| Address1: | 6621 FANNIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328241000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 04/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | GAGE | ||||||||
| AuthorizedOfficialFirstName: | WELDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8328283660 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 000117 | TX | Y | Hospitals | General Acute Care Hospital | Children |
ID Information
| ID | Type | State | Issuer | Description | 139135102 | 05 | TX | MEDICAID | 139135118 | 05 | TX | MEDICAID | 139135120 | 05 | TX | MEDICAID | 139135116 | 05 | TX | MEDICAID | 139135108 | 05 | TX | MEDICAID | 139135105 | 05 | TX | MEDICAID | 139135109 | 05 | TX | MEDICAID | 139135112 | 05 | TX | MEDICAID | 139135106 | 05 | TX | MEDICAID | 139135117 | 05 | TX | MEDICAID | HH0222 | 01 | TX | BCBS | OTHER |