Provider Demographics
NPI:1285078444
Name:THE SHRINERS' HOSPITAL FOR CHILDREN
Entity type:Organization
Organization Name:THE SHRINERS' HOSPITAL FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, FACHE
Authorized Official - Phone:413-787-2011
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:LOCKBOX 7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:413-787-2000
Mailing Address - Fax:413-755-2321
Practice Address - Street 1:516 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2330
Practice Address - Country:US
Practice Address - Phone:413-787-2000
Practice Address - Fax:413-755-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S100110458Medicare PIN
MA110094067DMedicaid
22303Medicare PIN