Provider Demographics
NPI:1760425474
Name:WASHINGTON UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY
Other - Org Name:WASHINGTON UNIVERSITY, DEPARTMENT OF UROLOGIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. DIRECTOR, WU MANAGED CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-273-0770
Mailing Address - Street 1:4240 DUNCAN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1123
Mailing Address - Country:US
Mailing Address - Phone:314-273-0770
Mailing Address - Fax:314-273-0575
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-273-0770
Practice Address - Fax:314-273-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO553061508Medicaid
MO553061508OtherMEDICAID PHARMACY NUMBER
MO673341OtherAETNA HMO GROUP
MO19-01999OtherUHC GROUP NUMBER
MO610916400OtherDEPARTMENT OF LABOR
MO6460186OtherSPECIAL HEALTH CARE NEEDS
IL92215227OtherBLUE SHIELD
MO8760OtherGHP MASTER VENDOR
MO000010219Medicare PIN
IL92215227OtherBLUE SHIELD
MO19-01999OtherUHC GROUP NUMBER
MO6460186OtherSPECIAL HEALTH CARE NEEDS
MO553061508OtherMEDICAID PHARMACY NUMBER
MOCC6123Medicare PIN
IL205476Medicare PIN