=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467442749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2005
-----------------------------------------------------
Last Update Date | 12/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 WELCH RD MAIL CODE 5500
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-497-8565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 WELCH RD MAIL CODE 5500
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94304-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-497-8357
-----------------------------------------------------
Fax | 650-493-2491
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. TIMOTHY CARMACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-736-0031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282NC2000X
-----------------------------------------------------
Taxonomy Name | Children's Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------