1417049610 NPI number — CURATORS OF THE UNIVERSITY OF MISSOURI

Table of content: (NPI 1417049610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417049610 NPI number — CURATORS OF THE UNIVERSITY OF MISSOURI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURATORS OF THE UNIVERSITY OF MISSOURI
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:
6
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:
1417049610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
PATIENT CARE CENTER
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63121-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-516-5131
Provider Business Mailing Address Fax Number:
314-516-5507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 JAMES R. THOMPSON BLVD
Provider Second Line Business Practice Location Address:
BUILDING D, STE 2030
Provider Business Practice Location Address City Name:
EAST ST. LOUIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62201-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-482-8355
Provider Business Practice Location Address Fax Number:
618-482-8360
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
VINITA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF CLINICAL OPERATIONS
Authorized Official Telephone Number:
314-516-6532

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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