Provider Demographics
NPI:1598797094
Name:SLH VISTA, INC.
Entity Type:Organization
Organization Name:SLH VISTA, INC.
Other - Org Name:SAINT LOUIS UNIVERSITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:PO BOX 741286
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1286
Mailing Address - Country:US
Mailing Address - Phone:678-242-2002
Mailing Address - Fax:314-577-8003
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-577-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
MO441-7282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154661601Medicaid
3284OtherCOVENTRY HEALTH CARE GROU
000443OtherHUMANA
171OtherBCBS OF MISSOURI
LA1748722Medicaid
260105B000000OtherSECTION 1011
KY01400704Medicaid
180984400OtherDEPT OF LABOR ACS
NC2600105Medicaid
GA000918629XMedicaid
SC11221AMedicaid
AR136563105Medicaid
1333OtherBCBS OF MISSOURI
VA2601052Medicaid
MO010671907Medicaid
VA2601052Medicaid