1427217116 NPI number — DR. CHRISTINA GESMUNDO SIMON MD

Table of content: DR. CHRISTINA GESMUNDO SIMON MD (NPI 1427217116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427217116 NPI number — DR. CHRISTINA GESMUNDO SIMON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
CHRISTINA
Provider Middle Name:
GESMUNDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1427217116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4511 FOREST PARK AVE
Provider Second Line Business Mailing Address:
STE 4300
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63108-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-286-1700
Provider Business Mailing Address Fax Number:
314-408-2756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHILDRENS PL
Provider Second Line Business Practice Location Address:
DIV PSYCHIATRY, CHILD AND ADOLESCENT
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:
314-286-1700
Provider Business Practice Location Address Fax Number:
314-286-1777
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  2010012945 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 205660202 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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