Provider Demographics
NPI: | 1083832364 |
---|---|
Name: | ST LOUIS UNIVERSITY |
Entity Type: | Organization |
Organization Name: | ST LOUIS UNIVERSITY |
Other - Org Name: | SLUCARE DEPT OF OTOLARYNGOLOGY-PEDIATRIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALYCE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LANXON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 314-977-6828 |
Mailing Address - Street 1: | 3545 LINDELL BLVD FL 3 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT LOUIS |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63103-1020 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 314-977-6828 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1465 S GRAND BLVD |
Practice Address - Street 2: | |
Practice Address - City: | SAINT LOUIS |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63104-1003 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-577-5650 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-23 |
Last Update Date: | 2021-09-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207YP0228X | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | Group - Multi-Specialty |