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General NPI Number Information
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NPI Number | 1598886970
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Entity Type | Organization
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Legal Business Name | ST LOUIS UNIVERSITY
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 3518 LACLEDE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63103-2011
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Country | US
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Telephone | 314-977-2323
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Fax | 314-977-7165
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Provider Business Mailing Address
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Address Line | 3545 LINDELL BLVD FL 3
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1020
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Country | US
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Telephone | 314-977-6828
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Fax | 314-977-7165
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ALYCE LANXON
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Credential |
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Telephone | 314-977-6828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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