1407864374 NPI number — LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD

Table of content: (NPI 1407864374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407864374 NPI number — LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
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:
6
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:
1407864374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 BOHANNON DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
MENLO PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94025-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-497-8316
Provider Business Mailing Address Fax Number:
650-497-8320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 BOHANNON DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MENLO PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94025-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-497-8316
Provider Business Practice Location Address Fax Number:
650-497-8320
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NG
Authorized Official First Name:
MARISA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST. DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
650-497-8391

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0549381 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ41694Z . This is a "BLUE SHIELD HOME INFUSION" identifier . This identifiers is of the category "OTHER".
  • Identifier: FP0549381 . This is a "BLUE SHIELD PHARM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003751 . This is a "BLUE CROSS PROVIDER#" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHA 407800 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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