Basic Information
| Provider Information | |||||||||
| NPI: | 1801158753 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST JUDE CHILDREN'S RESEARCH HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 DANNY THOMAS PL | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381053678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015953300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 262 DANNY THOMAS PL | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381053678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015953300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2012 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | ADDERSON | ||||||||
| AuthorizedOfficialFirstName: | ELISABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PED. ID FELLOWSHIP PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9015953459 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | Y | Hospitals | Special Hospital |
No ID Information.