Healthcare Provider Details

I. General information

NPI: 1700129145
Provider Name (Legal Business Name): BARNES JEWISH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1026
US

IV. Provider business mailing address

216 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1026
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number2009005235
License Number StateMO

VIII. Authorized Official

Name: MARY FREEMAN
Title or Position: CLINICAL MANAGER
Credential:
Phone: 314-747-0770