Provider Demographics
NPI:1639186760
Name:CHRISTIAN HOSPITAL NORTHEAST- NORTHWEST
Entity Type:Organization
Organization Name:CHRISTIAN HOSPITAL NORTHEAST- NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOESTERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-653-5715
Mailing Address - Street 1:11133 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6119
Mailing Address - Country:US
Mailing Address - Phone:314-653-5000
Mailing Address - Fax:314-653-4153
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6119
Practice Address - Country:US
Practice Address - Phone:314-653-5000
Practice Address - Fax:314-653-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X, 273Y00000X, 341600000X
MO4259282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
39OtherBLUE CROSS OF IL
MO10490605Medicaid
103187OtherHEALTHLINK
260180OtherMERCY HEALTHPLAN
5020061OtherUNITED HEALTHCARE
39OtherBLUE CROSS OF MO
769OtherGHP
=========019OtherTRICARE
MO10490605Medicaid
260180OtherMERCY HEALTHPLAN
769OtherGHP
260180OtherMERCY HEALTHPLAN