Basic Information
| Provider Information | |||||||||
| NPI: | 1871525766 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENET HEALTHSYSTEM ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN, LLC | ||||||||
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| OtherOrganizationName: | ST. CHRISTOPHERS HOSPITAL FOR CHILDREN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 828125 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191828125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152553152 | ||||||||
| FaxNumber: | 2154275555 | ||||||||
| Practice Location | |||||||||
| Address1: | ERIE AVENUE @ FRONT ST. | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154275000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | ARMIN | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF GOVT PROGRAMS, TENET | ||||||||
| AuthorizedOfficialTelephone: | 8184362267 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TENET HEALTHSYSTEM ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | 195601 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.