Healthcare Provider Details

I. General information

NPI: 1053665919
Provider Name (Legal Business Name): BARNES JEWISH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE 6TH FLOOR
SAINT LOUIS MO
63108-1402
US

IV. Provider business mailing address

5583 WATERMAN BLVD APT B
SAINT LOUIS MO
63112-4504
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2012020186
License Number StateMO

VIII. Authorized Official

Name: ANDY HSI
Title or Position: RESIDENT PHYSICIAN
Credential: M.D.
Phone: 832-922-9734