Healthcare Provider Details

I. General information

NPI: 1922448000
Provider Name (Legal Business Name): SCOTT BIRDWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST FLOOR EM ADMINISTRATION SAINT LOUIS UNIVERSITY HOSPITAL 3635 VISTA
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

1ST FLOOR EM ADMINISTRATION SAINT LOUIS UNIVERSITY HOSPITAL 3635 VISTA
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8780
  • Fax: 314-577-8516
Mailing address:
  • Phone: 314-577-8780
  • Fax: 314-577-8516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2013021984
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: