=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841519147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST JUDE MEDICAL S.C. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2010
-----------------------------------------------------
Last Update Date | 05/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6901 PRESTON RD
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-309-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 915002
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75391-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-309-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPTROLLER
-----------------------------------------------------
Name | MINH TRUONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-526-4868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------