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General NPI Number Information
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NPI Number | 1033789755
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Entity Type | Organization
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Legal Business Name | SHRINERS HOSPITALS FOR CHILDREN
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 1275 E FAIRFAX RD
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-4324
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Country | US
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Telephone | 801-536-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8500 LOCKBOX 7642
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City | PHILADELPHIA
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State | PA
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Zip | 19178-1435
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Country | US
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Telephone | 813-281-0300
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Fax | 813-281-0943
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY G. GANTT
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Credential |
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Telephone | 813-281-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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