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
3100 SAMFORD AVE, SHREVEPORT, LA 71103-4239
(318) 222-5704
(318) 424-7610
Mailing address
PO BOX 8500, LOCKBOX #7642, PHILADELPHIA, PA 19178-7642
(318) 222-5704
(318) 424-7610
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
07/16/2013
Last updated
09/20/2019
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