Provider Demographics
NPI:1073769329
Name:CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST
Entity Type:Organization
Organization Name:CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST
Other - Org Name:CHRISTIAN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOESTERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-653-5715
Mailing Address - Street 1:11133 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6119
Mailing Address - Country:US
Mailing Address - Phone:314-653-5000
Mailing Address - Fax:314-653-4153
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6119
Practice Address - Country:US
Practice Address - Phone:314-653-5000
Practice Address - Fax:314-653-4153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO425-9341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800490609Medicaid
MO800490609Medicaid