Healthcare Provider Details

I. General information

NPI: 1942343447
Provider Name (Legal Business Name): SHRINERS HOSPITALS FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 CLAYTON AVENUE
ST. LOUIS MO
63110-1624
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-432-3600
  • Fax: 314-432-2930
Mailing address:
  • Phone: 813-281-8478
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number142-53
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN GLOSS
Title or Position: ADMINISTRATOR
Credential: FACHE
Phone: 314-432-3600