Provider Demographics
NPI:1477119170
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:G
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-281-0300
Mailing Address - Street 1:PO BOX 8500 LOCKBOX #7642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-0300
Mailing Address - Fax:813-281-0943
Practice Address - Street 1:12502 USF PINE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9411
Practice Address - Country:US
Practice Address - Phone:813-972-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty