Healthcare Provider Details

I. General information

NPI: 1821587544
Provider Name (Legal Business Name): SHRINERS HOSPITALS FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S FAIR OAKS AVE
PASADENA CA
91105-2625
US

IV. Provider business mailing address

PO BOX 8500 LOCKBOX #7642
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-9300
  • Fax:
Mailing address:
  • Phone: 813-281-0300
  • Fax: 813-281-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JERRY G. GANTT
Title or Position: PRESIDENT
Credential:
Phone: 813-281-0300