1679617849 NPI number — SHRINERS HOSPITALS FOR CHILDREN

Table of content: (NPI 1679617849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679617849 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:
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:
1679617849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHRINERS HOSPITALS FOR CHILDREN
Provider Second Line Business Mailing Address:
P.O. BOX 8500, LOCKBOX #7642
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:
813-281-8657
Provider Business Mailing Address Fax Number:
813-281-8113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 SAMFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-222-5704
Provider Business Practice Location Address Fax Number:
318-424-7610
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
GARRY
Authorized Official Middle Name:
KIM
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-222-5704

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X , with the licence number:  179 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 149229 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 258361 . This is a "MEDICARE PART B (PTAN)" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2700031 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200341270A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191748105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08155267 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3168429 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179 . This is a "HOSPITAL LICENSE NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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