Provider Demographics
NPI:1033313259
Name:ST JUDE HOSPITAL INC
Entity Type:Organization
Organization Name:ST JUDE HOSPITAL INC
Other - Org Name:ST JUDE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, PATIENT FINANCIAL SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-870-3510
Mailing Address - Street 1:101 E VALENCIA MESA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3809
Mailing Address - Country:US
Mailing Address - Phone:714-992-3000
Mailing Address - Fax:714-870-3525
Practice Address - Street 1:2767 E IMPERIAL HWY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6713
Practice Address - Country:US
Practice Address - Phone:714-870-3510
Practice Address - Fax:714-870-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000173314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherMEDICARE -SNF
CA555367Medicare Oscar/Certification