Healthcare Provider Details

I. General information

NPI: 1437497666
Provider Name (Legal Business Name): SHRINERS HOSPITALS FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12502 USF PINE DR
TAMPA FL
33612-9411
US

IV. Provider business mailing address

PO BOX 8500 # 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2250
  • Fax: 813-975-7125
Mailing address:
  • Phone: 813-972-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number StateFL

VIII. Authorized Official

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