MEDICARE: ST LOUIS UNIVERSITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207ZI0100X	Immunopathology Physician
2	207ZP0007X	Molecular Genetic Pathology (Pathology) Physician
3	207ZC0500X	Cytopathology Physician

General Provider Information

NPI Number	:	1164495412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LOUIS UNIVERSITY

Provider Business Mailing Address
First Line	:	3545 LINDELL BLVD FL 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1020
Country	:	US
Telephone Number	:	314-977-6828
Fax Number	:	314-977-6872

Provider Business Practice Location Address
First Line	:	1402 SOUTH GRAND
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63104
Country	:	US
Telephone Number	:	314-577-8475
Fax Number	:	314-268-5478

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ALYCE LANXON
Credential	:
Telephone Number	:	314-977-6828

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	09/21/2021

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Directions to “ST LOUIS UNIVERSITY ” Practice Location

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