Provider Demographics
NPI:1629525928
Name:THE JOHN D. BOUHASIN CENTER FOR CHILDREN WITH BLEEDING DISORDERS
Entity Type:Organization
Organization Name:THE JOHN D. BOUHASIN CENTER FOR CHILDREN WITH BLEEDING DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE SYSTEM VP
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:REWERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2034
Mailing Address - Street 1:1465 S. GRAND
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1465 S. GRAND
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1095
Practice Address - Country:US
Practice Address - Phone:314-268-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARDINAL GLENNON CHILDRENS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty