Provider Demographics
NPI:1235235532
Name:WASHINGTON UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY
Other - Org Name:NEUROMUSCULAR LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-935-0770
Mailing Address - Street 1:7425 FORSYTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105
Mailing Address - Country:US
Mailing Address - Phone:314-935-0770
Mailing Address - Fax:314-935-0575
Practice Address - Street 1:509 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-3281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26D0652044291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO702840109Medicaid
MO000011474Medicare ID - Type Unspecified