NPIMap

Organization Active NPI

St. Jude Hospital, Inc.

  • Dental Clinic/Center
  • Buena Park, CA
National Provider Identifier
1063534501
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
ST. JUDE HOSPITAL, INC.
Practice address
7758 Knott Ave
Buena Park, CA 90620-2420
Phone
(714) 522-8723
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Barry Ross, RN
Title
Vice President, Healthy Communities
Phone
(714) 992-3164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X CA Primary

Addresses

Primary practice location

7758 Knott Ave
Buena Park, CA 90620-2420

Mailing address

7758 Knott Ave
Buena Park, CA 90620-2420
Phone (714) 522-8723

Other identifiers 1

IdentifierTypeStateIssuer
70894FMedicaidAR

Other names 1

  • St. Jude Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Jude Hospital Inc Dba St Jude Medical Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7758 Knott Ave
Buena Park, CA 90620
Phone (714) 522-8723

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1063534501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7758 KNOTT AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906202420",
            "telephone_number": "714-522-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7758 KNOTT AVE",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906202420",
            "telephone_number": "714-522-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "VICE PRESIDENT, HEALTHY COMMUNITIES",
        "authorized_official_telephone_number": "714-992-3164",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70894F",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Jude Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buena Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.