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PED053303-23 RADY CHILDREN'S HOSPITAL SAN DIEGO (Active)
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Main Details
Name
RADY CHILDREN'S HOSPITAL SAN DIEGO
Subdivision Name
Proton Beam Therapy Clinic
Type
Children's Hospital
Rural
No
340B ID
PED053303-23
Medicare Provider Number
053303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/2/2016
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
9730 SUMMERS RIDGE RD
RADY CHILDREN'S SPECIALISTS
SAN DIEGO, CA 92121-3101
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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