Organization
ST. JUDE HOSPITAL, INC.
Active
Parent organization
ST. JUDE HOSPITAL, INC.
Other names
St. Jude Mobile Health Clinic 1
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. JUDE HOSPITAL, INC.
Authorized official
MR. BARRY ROSS RN (VICE PRESIDENT, HEALTHY COMMUNITIES)
(714) 992-3164
Entity
Organization
Contact information
Practice address
731 SOUTH HIGHLAND AVENUE, FULLERTON, CA 92832
(714) 446-5100
Mailing address
731 SOUTH HIGHLAND AVENUE, FULLERTON, CA 92832
(714) 446-5100
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
70906F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70906F
—
CA
Enumeration date
04/17/2007
Last updated
02/27/2008
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