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NPI Code Detail

MEDICARE: ST JUDE CHILDRENS RESEARCH HOSPITAL INC

MEDICARE: ST JUDE CHILDRENS RESEARCH HOSPITAL INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0002XClinic Pharmacy843TN
2282NC2000XChildren's Hospital0000000113TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033112230
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST JUDE CHILDRENS RESEARCH HOSPITAL INC
Provider Business Mailing Address
First Line : 262 DANNY THOMAS PLACE MS 0515
Second Line : ST JUDE CHILDRENS RESEARCH HOSPITAL
City : MEMPHIS
State : TN
Zip : 38105-3678
Country : US
Telephone Number : 901-595-6863
Fax Number : 901-595-3842
Provider Business Practice Location Address
First Line : 262 DANNY THOMAS PL
Second Line :
City : MEMPHIS
State : TN
Zip : 38105-3678
Country : US
Telephone Number : 901-595-3300
Fax Number :
Authorized Official
Title or Position : SVP/CFO
Name : PATRICIA A. KEEL
Credential :
Telephone Number : 901-595-2916
Provider Enumeration Date : 05/23/2005
Last Update Date : 09/12/2018

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