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PED453301-31 Driscoll Children's Hospital (Active)
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Main Details
Name
Driscoll Children's Hospital
Subdivision Name
DRISCOLL CHILDRENS HOSPITAL - CPSST NEUROLOGY - BROWNSVILLE
Type
Children's Hospital
Rural
No
340B ID
PED453301-31
Medicare Provider Number
453301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/18/2021
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Driscoll Children's Hospital
Steven Eric King, CFO
(361) 694-5934
Primary Contact
Driscoll Children's Hospital
Jessy Varkey Thomas, Director of Pharmacy
(361) 694-5061
Addresses
Street Address
5500 NORTH EXPRESSWAY 77
DRISCOLL CHILDRENS HOSPITAL SPECIALITY CLINIC
BROWNSVILLE, TX 78526-4244
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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