Provider Demographics
NPI:1295497972
Name:ST JUDES MEDICAL CENTER
Entity type:Organization
Organization Name:ST JUDES MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:650-417-1127
Mailing Address - Street 1:9169 W STATE ST # 2133
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SAINT JUDES MEDICAL CENTER
Practice Address - Street 2:HEROICO COLEGIO MILITAR SN CENTRO
Practice Address - City:TODO SANTOS
Practice Address - State:BCS
Practice Address - Zip Code:23300
Practice Address - Country:MX
Practice Address - Phone:612-145-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
SJM180509CLAOtherSTATE