Provider Demographics
NPI:1528556776
Name:SHRINERS HOSPITALS FOR CHILDREN
Entity Type:Organization
Organization Name:SHRINERS HOSPITALS FOR CHILDREN
Other - Org Name:SHRINERS HOSPITALS FOR CHILDREN PROFESSIONAL ANESTHESIA SERVICES
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 LOCKBOX #7642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:813-281-0300
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:1275 E FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103
Practice Address - Country:US
Practice Address - Phone:801-536-3500
Practice Address - Fax:801-536-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty