=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295756195
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANKATA LAKSHMANA SAI LANKA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BARNES JEWISH HOSPITAL PLZ
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-362-6973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7425 FORSYTH BLVD CAMPUS BOX 8221
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-935-0770
-----------------------------------------------------
Fax | 314-935-0575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 2004018265
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------