Basic Information
| Provider Information | |||||||||
| NPI: | 1235148271 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARNES JEWISH ST. PETERS HOSPITAL INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | BARNES-JEWISH ST. PETERS HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369169000 | ||||||||
| FaxNumber: | 3149963610 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 HOSPITAL DR | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369169000 | ||||||||
| FaxNumber: | 3149963610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CALDER | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6369169401 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 102790 | 01 | HEALTH LINK | OTHER | 260191 | 01 | MERCY | OTHER | 6350770 | 01 | AETNA PPO | OTHER | 7676X7676 | 01 | HEALTHCARE USA | OTHER | 0059999 | 01 | AETNA HMO/POS | OTHER | 4DR81 | 01 | BLUE CROSS | OTHER | 542139308 | 05 | MO | MEDICAID | 012139309 | 05 | MO | MEDICAID |