Healthcare Provider Details

I. General information

NPI: 1659615706
Provider Name (Legal Business Name): SHRINERS HOSPITALS FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 N BROAD ST
PHILADELPHIA PA
19140-4160
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: 215-430-4079
Mailing address:
  • Phone: 215-430-4000
  • Fax: 215-430-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number StatePA

VIII. Authorized Official

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