Healthcare Provider Details

I. General information

NPI: 1982793139
Provider Name (Legal Business Name): SHRINERS HOSPITALS FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3009
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 503-294-3230
  • Fax: 503-221-3701
Mailing address:
  • Phone: 503-294-3230
  • Fax: 503-221-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number394874
License Number StateOR

VIII. Authorized Official

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