Organization
SHRINERS HOSPITALS FOR CHILDREN
Active
Other names
Shriners Hospitals for Children Professional Services
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY G. GANTT (PRESIDENT)
(813) 281-0300
Entity
Organization
Contact information
Practice address
4400 CLAYTON AVE, SAINT LOUIS, MO 63110-1624
(314) 432-3600
(314) 432-2930
Mailing address
PO BOX 8500, LOCKBOX #7642, PHILADELPHIA, PA 19178-7642
(314) 432-3600
(314) 432-2930
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/31/2013
Last updated
12/07/2022
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