Provider Demographics
NPI:1205278199
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:5096-230-4422
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:509-623-0422
Mailing Address - Fax:509-623-0474
Practice Address - Street 1:911 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2901
Practice Address - Country:US
Practice Address - Phone:509-623-0422
Practice Address - Fax:509-623-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992848857Medicaid
AKHS01OPW HS01IPWMedicaid
503302Medicare PIN
ID1992848857Medicaid
MT1992848857Medicaid