Provider Demographics
NPI:1356362586
Name:ST LOUIS CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:ST LOUIS CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-996-8401
Mailing Address - Street 1:PO BOX 956190
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-0001
Mailing Address - Country:US
Mailing Address - Phone:314-286-2373
Mailing Address - Fax:314-286-2693
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:314-286-2373
Practice Address - Fax:314-286-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO324-26261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1440650Medicaid
167OtherMISSOURI BLUE CROSS
518802OtherAETNA
103176OtherHEALTH LINK
17268OtherGHP AND CMR
5010193OtherUNITED HEALTHCARE
AR112148105Medicaid
FL901450100Medicaid
OK100693290AMedicaid
MO10930907Medicaid
LA1737518Medicaid
MO800930901Medicaid
MS95348Medicaid
ALHOS330INMedicaid
IA936377Medicaid
IA936377Medicaid
262309Medicare Oscar/Certification