Provider Demographics
NPI:1447313770
Name:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Entity type:Organization
Organization Name:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-736-0031
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:MAIL CODE 5500
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8357
Mailing Address - Fax:650-493-2491
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:MAIL CODE 5500
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8357
Practice Address - Fax:650-493-2491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC052390FMedicaid
CACDC052390FMedicaid