Provider Demographics
NPI:1508935891
Name:SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
Other - Org Name:SSM HEALTH ST. MARY'S HOSPITAL - ST. LOUIS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURGHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-577-5613
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5600
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:314-577-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO429282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100034340AMedicaid
CAXHSP32905Medicaid
KS100376220AMedicaid
LA1747416Medicaid
CO95018891Medicaid
MO010155802Medicaid
FL909155600Medicaid
MI404785069Medicaid
KY01441005Medicaid
MS02884096Medicaid
MI304785040Medicaid
MO540155801Medicaid
MN756053200Medicaid
CAXHSP42905Medicaid
MO010155810Medicaid
IA0966895Medicaid
MO429OtherLICENSE NUMBER
AK131582105Medicaid
KY01441005Medicaid
CAXHSP42905Medicaid