1710909486 NPI number — ST. LOUIS CHILDRENS HOSPITAL

Table of content: (NPI 1710909486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710909486 NPI number — ST. LOUIS CHILDRENS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LOUIS CHILDRENS 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:
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:
1710909486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CHILDRENS PL
Provider Second Line Business Mailing Address:
ADMINISTRATION, SUITE 3S-36
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-454-6044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

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:
314-454-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEE
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
314-454-6044

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  324-22 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 167 . This is a "MISSOURI BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 936377 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HOS330IN , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103176 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112148105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100693290A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1440650 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95348 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1737518 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5010193 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 518802 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 901450100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10930907 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17268 . This is a "GHP AND CMR" identifier . This identifiers is of the category "OTHER".




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