Provider Demographics
NPI:1356822993
Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
Other - Org Name:WUPI - DEPARTMENT OF UROLOGICAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. DIRECTOR, WU MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-273-0770
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-2611
Mailing Address - Fax:314-362-4969
Practice Address - Street 1:1418 CROSS ST STE 180
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2965
Practice Address - Country:US
Practice Address - Phone:314-362-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty