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PED053303-01 RADY CHILDREN'S HOSPITAL SAN DIEGO (Active)
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Main Details
Name
RADY CHILDREN'S HOSPITAL SAN DIEGO
Subdivision Name
Sanford Pediatric Clinic - Urgent Care Oceanside
Type
Children's Hospital
Rural
No
340B ID
PED053303-01
Medicare Provider Number
053303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/10/2014
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Rady Children's Hospital San Diego
Charles Brendan Davis, Regional President Rady Children's Health San Diego and COO Rady Children's Hospital San Diego
(858) 966-4001
Primary Contact
Rady Children's Hospital San Diego
Chris Abe, VP, Operations
(858) 966-5968
Addresses
Street Address
3605 Vista Way, Suite 172
Oceanside, CA 92056
Billing Address
Rady Children's Hospital San Diego
3020 Children's Way
San Diego, CA 92123
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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