1285674754 NPI number — WASHINGTON UNIVERSITY

Table of content: (NPI 1285674754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285674754 NPI number — WASHINGTON UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WASHINGTON UNIVERSITY, DEPT OF ANESTHESIA PSYCHOLOGY
Provider Other Organization Name Type Code:
5
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:
1285674754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7425 FORSYTH BLVD
Provider Second Line Business Mailing Address:
CAMPUS BOX 8221
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-935-0770
Provider Business Mailing Address Fax Number:
314-935-0575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 S EUCLID AVE
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:
63110-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-286-1045
Provider Business Practice Location Address Fax Number:
314-286-1051
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EGHIGIAN
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR, CREDENTIALING OPERATIONS
Authorized Official Telephone Number:
314-273-0770

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15-01999 . This is a "UHC GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 673341 . This is a "AETNA HMO GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 552990905 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92215225 . This is a "IL BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 610916400 . This is a "DEPT OF LABOR NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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