1760946156 NPI number — WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760946156 NPI number — WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
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:
WUPI - DEPARTMENT OF PLASTIC SURGERY
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:
1760946156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 S EUCLID AVE
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:
63110-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MEMORIAL DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62002-6723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-362-7388
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
EGHIGIAN
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIRECTOR, MANAGED CARE
Authorized Official Telephone Number:
618-791-0975

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)





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