Provider Demographics
NPI:1164811923
Name:SHRINERS HOSPITALS FOR CHILDREN
Entity Type:Organization
Organization Name:SHRINERS HOSPITALS FOR CHILDREN
Other - Org Name:SHRINERS HOSPITALS FOR CHILDREN AMBULATORY SURGERY CENTER-LEXINGTON
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-281-0300
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:LOCKBOX 7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:859-268-5630
Mailing Address - Fax:859-268-5636
Practice Address - Street 1:110 CONN TER
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3206
Practice Address - Country:US
Practice Address - Phone:859-268-5630
Practice Address - Fax:859-268-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical