Basic Information
| Provider Information | |||||||||
| NPI: | 1659359446 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCRIPPS HEALTH | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SCRIPPS MERCY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10790 RANCHO BERNARDO RD # 4S-303 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921275705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589275328 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4077 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192607101 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TANDE | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EVP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8586787227 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSC30077G | 01 | MEDI CAL HMO IN PATIENT | OTHER | ME | 01 | KAISER | OTHER | HSC30077G | 01 | MEDICAL INPATIENT | OTHER | ZZT40077G | 01 | MEDI CAL OUT PATIENT | OTHER | 050077 | 01 | BLUE CROSS | OTHER | 050077B000000 | 01 | 1011 FUND ANDMINISTERED | OTHER | 121MER | 01 | COUNTY MEDICAL SERVICES | OTHER | ZZT30077G | 01 | MEDICAL INPATIENT ADMINIS | OTHER | ZZT40077G | 01 | MEDI CAL HMO OUT PATIENT | OTHER | ZZZA3708Z | 01 | BLUE SHIELD | OTHER | 6152170 | 01 | AETNA | OTHER |