Basic Information
| Provider Information | |||||||||
| NPI: | 1477687218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 DODGE ST | ||||||||
| Address2: | CHILDREN'S HOSPITAL | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681144113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029555400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14421 DUPONT CT | ||||||||
| Address2: | CHILDREN'S HOSPITAL - URGENT CARE - HARVEY OAKS | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681442100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029557200 | ||||||||
| FaxNumber: | 4029557250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARNA | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR - REIMB & MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 4029556775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPA, MS, FHFMA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 283691 | 01 | COVENTRY | OTHER | 6600200 | 05 | NE | MEDICAID | D02979 | 01 | NE | BCBS | OTHER |