Provider Demographics
NPI:1528569845
Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC.
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC.
Other - Org Name:WUPI - PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING
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 1:4240 DUNCAN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1123
Mailing Address - Country:US
Mailing Address - Phone:314-273-0770
Mailing Address - Fax:314-273-0470
Practice Address - Street 1:1414 CROSS ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2988
Practice Address - Country:US
Practice Address - Phone:314-286-1264
Practice Address - Fax:314-286-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty