Provider Demographics
NPI:1619179561
Name:SAINT LOUIS UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:SAINT LOUIS UNIVERSITY MEDICAL CENTER
Other - Org Name:SLUCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WESTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-977-8462
Mailing Address - Street 1:12455 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3633
Mailing Address - Country:US
Mailing Address - Phone:314-579-6159
Mailing Address - Fax:314-771-8575
Practice Address - Street 1:1402 S GRAND BLVD # M238
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1004
Practice Address - Country:US
Practice Address - Phone:314-977-8462
Practice Address - Fax:314-771-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004-012733282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access