1154308005 NPI number — SCRIPPS HEALTH

Table of content: (NPI 1154308005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154308005 NPI number — SCRIPPS HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCRIPPS HEALTH
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:
1154308005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10790 RANCHO BERNARDO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92127-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-657-4218
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4077 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-7101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TANDE
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP/CFO
Authorized Official Telephone Number:
858-678-7227

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  050000074 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 050077 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSM30077G . This is a "MEDICAL IN PATIENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSM30077G . This is a "MEDICAL HMO IN PATIENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6152170 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZT40077G . This is a "MEDICAL HMO OUT PATIENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 090000074 . This is a "STATE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZA3708Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ME . This is a "KAISER" identifier . This identifiers is of the category "OTHER".




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