1508935891 NPI number — SSM CARDINAL GLENNON CHILDREN'S HOSPITAL

Table of content: (NPI 1508935891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508935891 NPI number — SSM CARDINAL GLENNON CHILDREN'S HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM CARDINAL GLENNON 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's Other Name Information

Provider Other Organization Name:
SSM HEALTH ST. MARY'S HOSPITAL - ST. LOUIS
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:
1508935891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1465 S GRAND BLVD
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:
63104-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-577-5600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1465 S GRAND BLVD
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:
63104-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-577-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURGHART
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-577-5613

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X , with the licence number:  429 , 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: 100034340A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP32905 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100376220A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1747416 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95018891 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010155802 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 909155600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404785069 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01441005 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02884096 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304785040 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540155801 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 756053200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP42905 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010155810 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0966895 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 429 . This is a "LICENSE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 131582105 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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