Basic Information
Provider Information
NPI: 1518114289
EntityType: 2
ReplacementNPI:  
OrganizationName: NATIONWIDECHILDREN'S HOSPITAL
LastName:  
FirstName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 700 CHILDRENS DR
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432052664
CountryCode: US
TelephoneNumber: 6147222000
FaxNumber:  
Practice Location
Address1: 700 CHILDRENS DR
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432052664
CountryCode: US
TelephoneNumber: 6147222000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/25/2008
LastUpdateDate: 08/25/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HEITZMAN
AuthorizedOfficialFirstName: MEGAN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PEDIATRIC RESIDENT
AuthorizedOfficialTelephone: 6147324457
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC2000X57.013701OHY HospitalsGeneral Acute Care HospitalChildren

No ID Information.


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