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NPI Code Detail

MEDICARE: ST LOUIS UNIVERSITY

MEDICARE: ST LOUIS UNIVERSITY
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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1730152067
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 :
Provider Business Practice Location Address
First Line : 1438 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1027
Country : US
Telephone Number : 314-977-6828
Fax Number : 314-977-4876
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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