1356514012 NPI number — WASHINGTON UNIVERSITY IN ST. LOUIS

Table of content: (NPI 1356514012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356514012 NPI number — WASHINGTON UNIVERSITY IN ST. LOUIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON UNIVERSITY IN ST. LOUIS
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:
1356514012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4940 PARKVIEW PL
Provider Second Line Business Mailing Address:
CAMPUS BOX 8230
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63110-1025
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:
4940 PARKVIEW PL
Provider Second Line Business Practice Location Address:
CAMPUS BOX 8230
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-362-7650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RIDDLE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
314-362-7650

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2001013439 , 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)





Copyright © 2007-2025 www.npivalidator.com