Provider Demographics
NPI:1558428235
Name:ST. JUDE HOSPITAL, INC. DBA ST. JUDE MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. JUDE HOSPITAL, INC. DBA ST. JUDE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-870-3510
Mailing Address - Street 1:101 E VALENCIA MESA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3809
Mailing Address - Country:US
Mailing Address - Phone:714-992-3000
Mailing Address - Fax:714-870-3525
Practice Address - Street 1:2767 E IMPERIAL HWY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6713
Practice Address - Country:US
Practice Address - Phone:714-870-3540
Practice Address - Fax:714-870-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000173282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT30168FMedicaid
CAHSC30168FMedicaid
CAZZT40168FMedicaid
CAHSC30168FMedicaid
CABT702AMedicare Oscar/Certification