Basic Information
| Provider Information | |||||||||
| NPI: | 1942801022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHMC COMMUNITY HEALTH SERVICES NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | CCHMC MEDICAL STAFF SERVICES | ||||||||
| Address2: | 3333 BURNET AVE., ML 5021 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136364225 | ||||||||
| FaxNumber: | 5136362511 | ||||||||
| Practice Location | |||||||||
| Address1: | 9600 CHILDREN DR BLDG D | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450406791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133366700 | ||||||||
| FaxNumber: | 5133982109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUTHRIE | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR MEDICAL STAFF SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 5136369691 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHMC COMMUNITY HEALTH SERVICES NETWORK | ||||||||
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| AuthorizedOfficialCredential: | MS, CPMSM, CPCS | ||||||||
| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.