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General NPI Number Information
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NPI Number | 1700325123
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Entity Type | Organization
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Legal Business Name | WUCA-WESTSIDE PEDIATRICS LLC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 100 BREVCO PLZ SUITE 101
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1382
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Country | US
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Telephone | 636-561-5437
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Fax | 636-561-5100
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Provider Business Mailing Address
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Address Line | PO BOX 7412119
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 636-561-5437
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Fax | 636-561-5100
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Authorized Official
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Title or Position | SENIOR DIRECTOR WU MANAGED CARE
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Name | MS. CATHY EGHIGIAN
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Credential |
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Telephone | 618-791-0975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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