Provider Demographics
NPI:1962442475
Name:WASHINGTON UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON UNIVERSITY
Other - Org Name:WASHINGTON UNIVERSITY DEPARTMENT OF RADIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING OPERATIONS
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:314-935-0770
Mailing Address - Street 1:510 S KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1016
Mailing Address - Country:US
Mailing Address - Phone:314-273-0770
Mailing Address - Fax:
Practice Address - Street 1:510 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-273-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0623733OtherSPECIAL HEALTH CARE NEEDS
MO3917OtherGHP MASTER VENDOR
MO559722707Medicaid
MO610916400OtherDEPARTMENT OF LABOR
MO673341OtherAETNA HMO GROUP
IL92215197OtherBLUE SHIELD
MO500GA2OtherBLUE SHIELD
MO16-01000OtherUHC GROUP NUMBER
MOCC9951Medicare PIN
IL92215197OtherBLUE SHIELD
MO000010377Medicare PIN
MOCC6123Medicare PIN
MO610916400OtherDEPARTMENT OF LABOR
MO559722707Medicaid
MOCQ2042Medicare PIN
MOCS5474Medicare PIN