Healthcare Provider Details

I. General information

NPI: 1952520587
Provider Name (Legal Business Name): SAINT LOUIS UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 VISTA AVE
SAINT LOUIS MO
63110-2540
US

IV. Provider business mailing address

3691 RUTGER ST
SAINT LOUIS MO
63110-2515
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-6125
  • Fax:
Mailing address:
  • Phone: 314-977-6828
  • Fax: 314-977-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN SEAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-977-6828