Provider Demographics
NPI:1467442749
Name:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Entity type:Organization
Organization Name:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-736-0031
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:MAIL CODE 5500
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8357
Mailing Address - Fax:650-493-2491
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:MAIL CODE 5500
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0 1241116Medicaid
HI54281201Medicaid
NMA5935Medicaid
ID002182000Medicaid
AZ355075Medicaid
CAHSC11103GMedicaid
ALLUC3305NMedicaid
GA00977963XMedicaid
LA1700479Medicaid
AKHS966Medicaid
CAZZR11103GMedicaid
CO95018255Medicaid
MT0 410737Medicaid
CAHSP41103GMedicaid
NV00 1189126Medicaid
KS100105870AMedicaid
FL912214100Medicaid
CAZZZB4301ZOtherBLUE SHIELD