Healthcare Provider Details

I. General information

NPI: 1073568226
Provider Name (Legal Business Name): SSM CARDINAL GLENNON CHILDRENS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/18/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 S . KINGS HIGHWAY BLVD
SAINT LOUIS MO
63139-1008
US

IV. Provider business mailing address

1173 CORPORATE LAKE DR
SAINT LOUIS MO
63132-1716
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-4070
  • Fax: 314-268-4019
Mailing address:
  • Phone: 314-989-6843
  • Fax: 314-344-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN REWERTS
Title or Position: SYSTEM VICE PRESIDENT FINANCE
Credential: CFO
Phone: 314-989-6843