Basic Information
| Provider Information | |||||||||
| NPI: | 1285775171 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHRINERS HOSPITALS FOR CHILDREN ERIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 8500 | ||||||||
| Address2: | LOCK BOX 8347 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191780001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132818478 | ||||||||
| FaxNumber: | 8132818113 | ||||||||
| Practice Location | |||||||||
| Address1: | 1645 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165055007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148758700 | ||||||||
| FaxNumber: | 8148758756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | WALCZAK | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8148758700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHRINERS HOSPITALS FOR CHILDREN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | 196801 | PA | Y | Hospitals | Special Hospital |
No ID Information.