Provider Demographics
NPI:1710909486
Name:ST. LOUIS CHILDRENS HOSPITAL
Entity Type:Organization
Organization Name:ST. LOUIS CHILDRENS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-454-6044
Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:ADMINISTRATION, SUITE 3S-36
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6044
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO324-22261QM0855X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
167OtherMISSOURI BLUE CROSS
IA936377Medicaid
ALHOS330INMedicaid
103176OtherHEALTH LINK
AR112148105Medicaid
OK100693290AMedicaid
KY1440650Medicaid
MS95348Medicaid
LA1737518Medicaid
5010193OtherUNITED HEALTHCARE
518802OtherAETNA
FL901450100Medicaid
MO10930907Medicaid
17268OtherGHP AND CMR
KY1440650Medicaid
990001253Medicare PIN
KY1440650Medicaid