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Organization
SHRINERS HOSPITALS FOR CHILDREN
Active
Organization
SHRINERS HOSPITALS FOR CHILDREN
Active
Other names
Shriners Hospitals for Children Professional Anesthesia Services
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY G. GANTT (PRESIDENT)
(813) 281-0300
Entity
Organization
Contact information
Practice address
3551 N BROAD ST, PHILADELPHIA, PA 19140-4160
(215) 430-4000
(215) 430-4079
Mailing address
PO BOX 8500 LOCKBOX #7642, PHILADELPHIA, PA 19178-7642
(813) 281-0300
(813) 281-8113
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
207LP3000X
Pediatric Anesthesiology Physician
—
NULL
207LP3000X
Pediatric Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
NULL
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
04/24/2018
Last updated
02/08/2019
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