Healthcare Provider Details

I. General information

NPI: 1619179561
Provider Name (Legal Business Name): SAINT LOUIS UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD # M238
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

12455 MARINE AVE
MARYLAND HEIGHTS MO
63043-3633
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-8462
  • Fax: 314-771-8575
Mailing address:
  • Phone: 314-579-6159
  • Fax: 314-771-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2004-012733
License Number StateMO

VIII. Authorized Official

Name: MS. MELISSA A WESTWOOD
Title or Position: ADMINISTRATIVE SECRETARY
Credential:
Phone: 314-977-8462