Provider Demographics
NPI:1114959582
Name:TENET HEALTHSYSTEM ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN, LLC
Entity Type:Organization
Organization Name:TENET HEALTHSYSTEM ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN, LLC
Other - Org Name:ST. CHRISTOPHERS HOSPITAL FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:PO BOX 828125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8125
Mailing Address - Country:US
Mailing Address - Phone:215-255-3152
Mailing Address - Fax:215-427-5555
Practice Address - Street 1:ERIE AVENUE @ FRONT ST.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1095
Practice Address - Country:US
Practice Address - Phone:215-427-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QA1903X
PA195601282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019369900Medicaid
PA1007296720002Medicaid
75-2522262OtherBETTER HEALTH PLAN
CT003114767Medicaid
CO64872238Medicaid
CAHSP231515Medicaid
ALSTC00301NMedicaid
IN100470930Medicaid
PA1007296720007Medicaid
2311OtherINDEPENDENCE BLUE CROSS
00017OtherHEALTH PARTNERS
MI4660903Medicaid
PA1007296720010Medicaid
MN378638200Medicaid
MI4660897Medicaid
MA7009461Medicaid
GA000757589YMedicaid
GA00757589XMedicaid
393307OtherHORIZON NJ-BCBS HEALTH
GA000757589YMedicaid