Healthcare Provider Details

I. General information

NPI: 1033112230
Provider Name (Legal Business Name): ST JUDE CHILDRENS RESEARCH HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

262 DANNY THOMAS PLACE MS 0515 ST JUDE CHILDRENS RESEARCH HOSPITAL
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3300
  • Fax:
Mailing address:
  • Phone: 901-595-6863
  • Fax: 901-595-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number0000000113
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number843
License Number StateTN

VIII. Authorized Official

Name: PATRICIA A. KEEL
Title or Position: SVP/CFO
Credential:
Phone: 901-595-2916