Provider Demographics
NPI:1255461075
Name:SHRINERS HOSPITALS FOR CHILDREN
Entity type:Organization
Organization Name:SHRINERS HOSPITALS FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-536-3700
Mailing Address - Street 1:SHRINERS HOSPITAL FOR CHILDREN SALT
Mailing Address - Street 2:P.O. BOX 8500 LOCKBOX #7462
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:801-536-3714
Mailing Address - Fax:801-536-3799
Practice Address - Street 1:1275 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-4324
Practice Address - Country:US
Practice Address - Phone:801-536-3714
Practice Address - Fax:801-536-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSP-2006282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2005-HOSP-206OtherSTATE FACILITY LICENSE