Healthcare Provider Details

I. General information

NPI: 1669644456
Provider Name (Legal Business Name): SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD SUITE 120
SAINT CHARLES MO
63304-8781
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 636-498-7878
  • Fax: 636-498-7420
Mailing address:
  • Phone: 314-577-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. SHARON DUDLEY
Title or Position: EVP/COO
Credential:
Phone: 314-768-8032