Provider Demographics
NPI:1134561020
Name:SHRINERS HOSPITALS FOR CHILDREN
Entity type:Organization
Organization Name:SHRINERS HOSPITALS FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:
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:503-294-3230
Mailing Address - Fax:503-221-3701
Practice Address - Street 1:3101 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3009
Practice Address - Country:US
Practice Address - Phone:503-294-3230
Practice Address - Fax:503-221-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XP3100X
OR394874282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134561020Medicare PIN
WA2015176Medicaid
ID1982793139Medicaid
AKHS10RIP SH10ROPMedicaid
OR271154Medicaid