Organization
SHRINERS HOSPITALS FOR CHILDREN
Active
Other names
Shriners Hospitals for Children Rehabilitation Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY G. GANTT (PRESIDENT)
(813) 281-0300
Entity
Organization
Contact information
Practice address
1275 E FAIRFAX RD, SALT LAKE CITY, UT 84103-4324
(801) 536-3500
Mailing address
PO BOX 8500 LOCKBOX 7642, PHILADELPHIA, PA 19178-1435
(813) 281-0300
(813) 281-0943
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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