Healthcare Provider Details

I. General information

NPI: 1033879713
Provider Name (Legal Business Name): SHRINERS HOSPITALS FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 W STATE ST STE 305
DOYLESTOWN PA
18901-2567
US

IV. Provider business mailing address

PO BOX 8500 LOCKBOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 215-430-4000
  • Fax: 215-430-4228
Mailing address:
  • Phone: 813-281-0300
  • Fax: 813-281-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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