MEDICARE: LOS NINOS HOSPITAL INC

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	3336I0012X	Institutional Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336L0003X	Long Term Care Pharmacy	Y004230	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1992397	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710091780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS NINOS HOSPITAL INC

Provider Business Mailing Address
First Line	:	1402 E SOUTH MOUNTAIN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7925
Country	:	US
Telephone Number	:	602-243-4231
Fax Number	:	602-323-5988

Provider Business Practice Location Address
First Line	:	2303 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7827
Country	:	US
Telephone Number	:	602-954-7311
Fax Number	:	602-954-7355

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM TIMMONS
Credential	:
Telephone Number	:	602-243-4231

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	04/29/2014

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Directions to “LOS NINOS HOSPITAL INC ” Practice Location

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