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)
(218) 281-0300
Entity
Organization
Contact information
Practice address
2211 N OAK PARK AVE, CHICAGO, IL 60707-3351
(773) 385-5400
(773) 385-5453
Mailing address
PO BOX 8500, LOCKBOX #7642, PHILADELPHIA, PA 19178-7642
(773) 385-5445
(773) 385-5453
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
06/03/2013
Last updated
01/13/2023
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