Healthcare Provider Details

I. General information

NPI: 1124416037
Provider Name (Legal Business Name): CHRISTIAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD
SAINT LOUIS MO
63136-6163
US

IV. Provider business mailing address

3440 RIVER HEIGHTS XING SE
MARIETTA GA
30067-4500
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5000
  • Fax:
Mailing address:
  • Phone: 678-935-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberIN PROCESS
License Number StateMO

VIII. Authorized Official

Name: STEVE KANE
Title or Position: SENIOR PRACTICE MANAGER
Credential:
Phone: 614-499-6325