Basic Information
| Provider Information | |||||||||
| NPI: | 1194765685 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON UNIVERSITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 SOUTH EUCLID AVENUE | ||||||||
| Address2: | CAMPUS BOX 8515 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631052171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142730770 | ||||||||
| FaxNumber: | 3142730470 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PL | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142861264 | ||||||||
| FaxNumber: | 3142861258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | EGHIGIAN | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SR DIRECTOR, MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 3142730770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 673341 | 01 | MO | AETNA HMO GROUP | OTHER | 92215224 | 01 | IL | BLUE SHIELD | OTHER | 3775 | 01 | MO | GHP MASTER VENDOR | OTHER | 4DP71 | 01 | MO | BLUE SHIELD | OTHER | 552927600 | 01 | MO | MEDICAID PHARMACY | OTHER | 552927600 | 05 | MO | MEDICAID | 610916400 | 01 | MO | DEPARTMENT OF LABOR | OTHER | 75-02999 | 01 | MO | UHC GROUP | OTHER |