Provider Demographics
NPI:1528005642
Name:WASHINGTON UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY
Other - Org Name:WASHINGTON UNIVERSITY, DEPT OF ANESTHESIOLOGY
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:L
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-273-0770
Mailing Address - Street 1:4240 DUNCAN AVE
Mailing Address - Street 2:CAMPUS BOX 8221
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1108
Mailing Address - Country:US
Mailing Address - Phone:314-273-0770
Mailing Address - Fax:314-273-0770
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-286-1045
Practice Address - Fax:314-286-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO103DP2OtherBLUESHIELDBILLINGCODE
MO610916400OtherDEPT OF LABOR NUMBER
MO673341OtherAETNA HMO GROUP NUMBER
MO3599OtherGHP MASTER VENDOR NUMBER
IL92215218OtherIL BLUE SHIELD NUMBER
MO0001741OtherMOSPECIALHEALTHCARENEEDS
MO552944803Medicaid
MO20-01999OtherUHC GROUP NUMBER
MO1528005642Medicaid
IL205475Medicare PIN
MO103DP2OtherBLUESHIELDBILLINGCODE
MO610916400OtherDEPT OF LABOR NUMBER
IL92215218OtherIL BLUE SHIELD NUMBER
MO0001741OtherMOSPECIALHEALTHCARENEEDS