1255461075 NPI number — SHRINERS HOSPITALS FOR CHILDREN

Table of content: (NPI 1255461075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255461075 NPI number — SHRINERS HOSPITALS FOR CHILDREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHRINERS HOSPITALS FOR CHILDREN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255461075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHRINERS HOSPITAL FOR CHILDREN SALT
Provider Second Line Business Mailing Address:
P.O. BOX 8500 LOCKBOX #7462
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-7642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-536-3714
Provider Business Mailing Address Fax Number:
801-536-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 FAIRFAX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84103-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-536-3714
Provider Business Practice Location Address Fax Number:
801-536-3799
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
HOSPITAL ADMINISTRATOR
Authorized Official Telephone Number:
801-536-3700

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X , with the licence number:  2005-HOSP-2006 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2005-HOSP-206 . This is a "STATE FACILITY LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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