Provider Demographics
NPI:1184460099
Name:ST JUDE CHILDREN'S RESEARCH HOSPITAL
Entity type:Organization
Organization Name:ST JUDE CHILDREN'S RESEARCH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOWSHIP PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDELHAFEEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELHAFEEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-595-2911
Mailing Address - Street 1:262 DANNY THOMAS PL # MS 133
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-2911
Mailing Address - Fax:901-595-2207
Practice Address - Street 1:262 DANNY THOMAS PL # MS 133
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-2911
Practice Address - Fax:901-595-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty