Provider Demographics
NPI:1215379102
Name:SHRINERS HOSPITALS FOR CHILDREN
Entity Type:Organization
Organization Name:SHRINERS HOSPITALS FOR CHILDREN
Other - Org Name:SHRINERS HOSPITALS FOR CHILDREN (PROFESSIONAL SERVICES)
Other - Org Type:Other Name
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-388-3350
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:#7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:213-368-3350
Mailing Address - Fax:213-639-3451
Practice Address - Street 1:3160 GENEVA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1117
Practice Address - Country:US
Practice Address - Phone:213-348-3350
Practice Address - Fax:213-639-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215379102Medicare PIN
053310Medicare PIN
NV1508908591Medicaid
UT1508908591Medicaid
CA1508908591Medicaid