Healthcare Provider Details

I. General information

NPI: 1194273276
Provider Name (Legal Business Name): WASHINGTON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE CAMPUS BOX 8111
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 SOUTH EUCLID AVENUE CAMPUS BOX 8111
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-6981
  • Fax:
Mailing address:
  • Phone: 314-362-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number2016011080
License Number StateMO

VIII. Authorized Official

Name: DR. AHMED KHAMIS BAMAGA
Title or Position: NEUROMUSCULAR FELLOW/CHILD NEUROLOG
Credential: M.D
Phone: 314-362-6981