Provider Demographics
NPI:1083676290
Name:SELWYN PICKER INC
Entity Type:Organization
Organization Name:SELWYN PICKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SELWYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-251-6267
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 310A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6267
Mailing Address - Fax:314-251-5871
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 310A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6267
Practice Address - Fax:314-251-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36202207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25715OtherBLUE CROSS BLUE SHIELD
MO3175711001OtherCIGNA
MO34211OtherGROUP HEALTH PLAN
MO0600012OtherUNITED HEALTHCARE
MO131961OtherHEALTHLINK
MOA13944Medicare UPIN