Healthcare Provider Details

I. General information

NPI: 1306962360
Provider Name (Legal Business Name): BARNES JWEISH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

530 UNION BLVD APT 804
SAINT LOUIS MO
63108-1146
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-2971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number2006036879
License Number StateMO

VIII. Authorized Official

Name: KRUPA SHAH
Title or Position: FELLOW
Credential: MD
Phone: 281-773-6387