Basic Information
Provider Information
NPI: 1376577262
EntityType: 2
ReplacementNPI:  
OrganizationName: TENET HEALTHSYSTEM SL, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: SAINT LOUIS UNIVERSITY HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 741286
Address2:  
City: ATLANTA
State: GA
PostalCode: 303741286
CountryCode: US
TelephoneNumber: 6782422002
FaxNumber: 3145778003
Practice Location
Address1: 3635 VISTA AVE
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631102539
CountryCode: US
TelephoneNumber: 3145778000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 03/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ARMIN
AuthorizedOfficialFirstName: CRAIG
AuthorizedOfficialMiddleName: C.
AuthorizedOfficialTitleorPosition: VP OF GOVT PROGRAMS, TENET
AuthorizedOfficialTelephone: 8184362267
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X441-7MOY HospitalsGeneral Acute Care Hospital 

No ID Information.


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