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General NPI Number Information
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NPI Number | 1376902932
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Entity Type | Organization
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Legal Business Name | BJC
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 11133 DUNN RD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6163
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Country | US
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Telephone | 314-653-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 92 ROTTINGHAM CT
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3685
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Country | US
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Telephone | 573-268-2749
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Fax |
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Authorized Official
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Title or Position | STAFF NURSE
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Name | MR. EDWARD JIM VREDENBURGH III
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Credential | BSN
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Telephone | 573-268-2749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 041.392442
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 2001004428
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License Number State | MO
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