PROVIDENCE ST. JUDE MEDICAL CENTER; NPI #1891904942
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Contact Information

PROVIDENCE ST. JUDE MEDICAL CENTER
LBN ST JUDE HOSPITAL INC
2767 E IMPERIAL HWY
SECOND FLOOR
BREA, CA92821-6713
 Phone: 714-870-3510
 Fax: 714-870-3525
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Acute Care Hospital

282N00000X A0[7] Hospital-General
Indicates primary specialty

NPI Profile & details for PROVIDENCE ST. JUDE MEDICAL CENTER

NPI # 1891904942
LBN Legal business name ST JUDE HOSPITAL INC
DBA Doing business as PROVIDENCE ST. JUDE MEDICAL CENTER
Authorized official DONALD ANDERSON - (ASSISTANT SECRETARY FOR ENROLLMENT)
Entity Organization
Organization subpart 1 No
Enumeration date 05/22/2007
Last updated 06/10/2021 - About 3 years ago
Identifiers
CA License # 060000173
CA Medicaid HSC30168F
CA Medicaid ZZT30168F
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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