Provider Demographics
NPI:1417907940
Name:LPCH MEDICAL GROUP DIV OF LUCILE
Entity Type:Organization
Organization Name:LPCH MEDICAL GROUP DIV OF LUCILE
Other - Org Name:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HAERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-721-2222
Mailing Address - Street 1:4700 BOHANNON DR
Mailing Address - Street 2:MC 5530
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-498-6762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04086ZMedicare PIN