Provider Demographics
NPI:1366452930
Name:CHRISTIAN HOSPITAL NORTHEAST- NORTHWEST
Entity Type:Organization
Organization Name:CHRISTIAN HOSPITAL NORTHEAST- NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KATSIANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-653-5062
Mailing Address - Street 1:1225 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8014
Mailing Address - Country:US
Mailing Address - Phone:314-653-5000
Mailing Address - Fax:314-653-4153
Practice Address - Street 1:1225 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8014
Practice Address - Country:US
Practice Address - Phone:314-653-5000
Practice Address - Fax:314-653-4153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO425-9282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
39OtherBLUE CROSS OF MO
MO10490704Medicaid
39OtherBLUE CROSS OF IL
4356057893OtherAETNA
4356057893OtherAETNA
39OtherBLUE CROSS OF IL