MEDICARE: WASHINGTON UNIVERSITY CLINICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1053561423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON UNIVERSITY CLINICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1110 HIGHLANDS PLAZA DR E
Second Line	:	SUITE 375
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1340
Country	:	US
Telephone Number	:	314-367-3113
Fax Number	:	314-454-9382

Provider Business Practice Location Address
First Line	:	1110 HIGHLANDS PLAZA DR E
Second Line	:	SUITE 375
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1340
Country	:	US
Telephone Number	:	314-367-3113
Fax Number	:	314-454-9382

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CATHY EGHIGIAN
Credential	:
Telephone Number	:	314-935-0770

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	02/10/2009

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