1356362586 NPI number — ST LOUIS CHILDREN'S HOSPITAL

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356362586 NPI number — ST LOUIS CHILDREN'S HOSPITAL

Employer Identification Number (EIN):

Provider Organization Name:

ST LOUIS CHILDREN'S HOSPITAL

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1356362586

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/16/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 956190

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAINT LOUIS

Provider Business Mailing Address State Name:

MO

Provider Business Mailing Address Postal Code:

63195-0001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

314-286-2373

Provider Business Mailing Address Fax Number:

314-286-2693

Provider First Line Business Practice Location Address:

1 CHILDRENS PL

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAINT LOUIS

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

63110-1002

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

314-286-2373

Provider Business Practice Location Address Fax Number:

314-286-2693

Provider Enumeration Date:

07/22/2006

Authorized Official Last Name:

LOLLO

Authorized Official First Name:

TRISHA

Authorized Official Middle Name:

Authorized Official Title or Position:

PRESIDENT

Authorized Official Telephone Number:

314-996-8401

• Taxonomy code: 261QE0700X , with the licence number:  324-26 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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• Identifier: 167 . This is a "MISSOURI BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 518802 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 103176 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".
• Identifier: 17268 . This is a "GHP AND CMR" identifier . This identifiers is of the category "OTHER".
• Identifier: 5010193 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 112148105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 901450100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 100693290A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: 10930907 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 1737518 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
• Identifier: 800930901 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 95348 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: HOS330IN , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 936377 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".