Provider Demographics
NPI:1306819644
Name:ST LOUIS UNIVERSITY
Entity Type:Organization
Organization Name:ST LOUIS UNIVERSITY
Other - Org Name:SLUCARE DEPARTMENT OF ORTHOPAEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
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 1:1225 SOUTH GRAND
Practice Address - Street 2:1L, DOOR 3,4
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-6310
Practice Address - Country:US
Practice Address - Phone:314-257-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000010255Medicare PIN