Basic Information
| Provider Information | |||||||||
| NPI: | 1336639780 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHRINERS HOSPITALS FOR CHILDREN | ||||||||
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| OtherOrganizationName: | SHRINERS HOSPITALS FOR CHILDREN PRO ANESTHESIA SERVICES-LEXINGTON | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 N ROCKY POINT DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336071435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132810300 | ||||||||
| FaxNumber: | 8132810943 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 CONN TER | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405083206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592662101 | ||||||||
| FaxNumber: | 8592685636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2018 | ||||||||
| LastUpdateDate: | 05/11/2018 | ||||||||
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| AuthorizedOfficialLastName: | GANTT | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8132810300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.