NPIMap

Organization Active NPI

St. Jude Hospital, Inc.

  • Primary Care Clinic/Center
  • Fullerton, CA
National Provider Identifier
1386869907
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
70906F Issued in CA
Legal business name
ST. JUDE HOSPITAL, INC.
Practice address
731 South Highland Avenue
Fullerton, CA 92832
Phone
(714) 446-5100
NPI assigned
Apr 17, 2007
Organization subpart
Yes
Parent organization
ST. JUDE HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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
Primary Care Clinic/Center 261QP2300X 70906F CA Primary

Addresses

Primary practice location

731 South Highland Avenue
Fullerton, CA 92832

Mailing address

731 South Highland Avenue
Fullerton, CA 92832
Phone (714) 446-5100

Other identifiers 1

IdentifierTypeStateIssuer
CMM70906FMedicaidCA

Other names 1

  • St. Jude Mobile Health Clinic 1 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
Part of
St Jude Hospital Inc Dba St Jude Medical Center

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1386869907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 SOUTH HIGHLAND AVENUE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92832",
            "telephone_number": "714-446-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 SOUTH HIGHLAND AVENUE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92832",
            "telephone_number": "714-446-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JUDE HOSPITAL, INC.",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-02-27",
        "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": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "70906F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70906F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Jude Mobile Health Clinic 1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; 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.