MEDICARE: CHRISTIAN HOSPITAL NORTHEAST NORTHWEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PS005673	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2625424	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1144336058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN HOSPITAL NORTHEAST NORTHWEST

Provider Business Mailing Address
First Line	:	1224 GRAHAM RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8028
Country	:	US
Telephone Number	:	314-953-6740
Fax Number	:	314-953-6921

Provider Business Practice Location Address
First Line	:	1224 GRAHAM RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8028
Country	:	US
Telephone Number	:	314-953-6740
Fax Number	:	314-953-6921

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	MARY WEHKING
Credential	:
Telephone Number	:	314-953-6740

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	09/06/2012

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Directions to “CHRISTIAN HOSPITAL NORTHEAST NORTHWEST ” Practice Location

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