Provider Demographics
| NPI: | 1275271462 |
|---|---|
| Name: | SHRINERS HOSPITALS FOR CHILDREN |
| Entity Type: | Organization |
| Organization Name: | SHRINERS HOSPITALS FOR CHILDREN |
| Other - Org Name: | SHRINERS CHILDREN'S MEDICAL GROUP |
| Other - Org Type: | Doing Business As |
| 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 LOCKBOX 7642 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHILADELPHIA |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 19178-7642 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 813-518-7679 |
| Mailing Address - Fax: | 813-281-8656 |
| Practice Address - Street 1: | 3551 N BROAD ST |
| Practice Address - Street 2: | |
| Practice Address - City: | PHILADELPHIA |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 19140-4160 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 813-518-7679 |
| Practice Address - Fax: | 813-281-8656 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-05-26 |
| Last Update Date: | 2024-03-13 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
