SHRINERS HOSPITALS FOR CHILDREN

Provider Demographics

• NPI: 1568809358
• 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: PRESIDENT
• Authorized Official - First Name: JERRY
• Authorized Official - Middle Name: G
• Authorized Official - Last Name: GANTT
• Authorized Official - Phone: 813-281-0300
• Mailing Address - Street 1: PO BOX 8500
• Mailing Address - Street 2: LOCKBOX #7642
• Mailing Address - City: PHILADELPHIA
• Mailing Address - State: PA
• Mailing Address - Zip Code: 19178-7642
• Mailing Address - Country: US
• Mailing Address - Phone: 513-872-6052
• Mailing Address - Fax: 513-872-6115
• Practice Address - Street 1: 1 CHILDREN'S PLAZA
• Practice Address - Street 2: 2 WEST
• Practice Address - City: DAYTON
• Practice Address - State: OH
• Practice Address - Zip Code: 45404-1815
• Practice Address - Country: US
• Practice Address - Phone: 513-872-6000
• Practice Address - Fax: 513-872-6025
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2013-06-03
• Last Update Date: 2024-01-08

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2086S0122X	Allopathic & Osteopathic Physicians	Surgery	Plastic and Reconstructive Surgery	Group - Multi-Specialty
No	2086S0120X	Allopathic & Osteopathic Physicians	Surgery	Pediatric Surgery	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TN	1527605	Medicaid
IN	201065900B	Medicaid
OH	0050729	Medicaid
FL	1659590644	Medicaid
VA	1659590644	Medicaid
KY	7100193970	Medicaid
	363308	Medicare PIN
WV	3810022971	Medicaid
IA	1659590644	Medicaid
MO	1659590644	Medicaid
IL	=========003	Medicaid
GA	003115775B	Medicaid