MEDICARE: SCRIPPS HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273R00000X	Psychiatric Hospital Unit	050000074	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	050077	OTHER	BLUE CROSS
2	HSM30077G	OTHER	MEDICAL IN PATIENT
3	HSM30077G	OTHER	MEDICAL HMO IN PATIENT
4	6152170	OTHER	AETNA
5	ZZT40077G	OTHER	MEDICAL HMO OUT PATIENT
6	090000074	OTHER	STATE LICENSE
7	ZZZA3708Z	OTHER	BLUE SHIELD
8	ME	OTHER	KAISER

General Provider Information

NPI Number	:	1154308005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCRIPPS HEALTH

Provider Business Mailing Address
First Line	:	10790 RANCHO BERNARDO RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-5705
Country	:	US
Telephone Number	:	858-657-4218
Fax Number	:

Provider Business Practice Location Address
First Line	:	4077 5TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2105
Country	:	US
Telephone Number	:	619-260-7101
Fax Number	:

Authorized Official
Title or Position	:	EVP/CFO
Name	:	BRETT TANDE
Credential	:
Telephone Number	:	858-678-7227

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/11/2022

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Directions to “SCRIPPS HEALTH ” Practice Location

Language	Start Address	Practice Location

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