Healthcare Provider Details

I. General information

NPI: 1861605271
Provider Name (Legal Business Name): WASHINGTON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE CAMPUS BOX 8518
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

3278 JANUARY AVE APT 2
SAINT LOUIS MO
63139-1743
US

V. Phone/Fax

Practice location:
  • Phone: 314-445-7757
  • Fax:
Mailing address:
  • Phone: 314-229-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number2004015125
License Number StateMO

VIII. Authorized Official

Name: DR. PAULINE NATIVIDAD IGNACIO
Title or Position: CHIEF RESIDENT
Credential: M.D.
Phone: 314-229-7944