Healthcare Provider Details

I. General information

NPI: 1396187282
Provider Name (Legal Business Name): SHRINERS HOSPITALS FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E FAIRFAX RD
SALT LAKE CITY UT
84103-4324
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-536-3714
  • Fax: 801-536-3799
Mailing address:
  • Phone: 801-536-3714
  • Fax: 801-536-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CRAIG MARTIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-536-3700