Basic Information
| Provider Information | |||||||||
| NPI: | 1598797094 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SLH VISTA, INC. | ||||||||
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| OtherOrganizationName: | SAINT LOUIS UNIVERSITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| 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 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | ARMIN | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF GOVT PROGRAMS, TENET | ||||||||
| AuthorizedOfficialTelephone: | 8184362267 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 441-7 | MO | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 154661601 | 05 | TX | MEDICAID | 3284 | 01 | COVENTRY HEALTH CARE GROU | OTHER | 000443 | 01 | HUMANA | OTHER | 171 | 01 | BCBS OF MISSOURI | OTHER | 1748722 | 05 | LA | MEDICAID | 260105B000000 | 01 | SECTION 1011 | OTHER | 01400704 | 05 | KY | MEDICAID | 180984400 | 01 | DEPT OF LABOR ACS | OTHER | 2600105 | 05 | NC | MEDICAID | 000918629X | 05 | GA | MEDICAID | 11221A | 05 | SC | MEDICAID | 136563105 | 05 | AR | MEDICAID | 1333 | 01 | BCBS OF MISSOURI | OTHER | 2601052 | 05 | VA | MEDICAID | 010671907 | 05 | MO | MEDICAID |