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PED053303-21 RADY CHILDREN'S HOSPITAL SAN DIEGO (Active)
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Main Details
Name
RADY CHILDREN'S HOSPITAL SAN DIEGO
Subdivision Name
Pediatric Gynecology / Pediatric Gynecology
Type
Children's Hospital
Rural
No
340B ID
PED053303-21
Medicare Provider Number
053303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/13/2015
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
7920 Frost St Suite #200
San Diego, CA 92123
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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