Basic Information
| Provider Information | |||||||||
| NPI: | 1639186760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTIAN HOSPITAL NORTHEAST- NORTHWEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11133 DUNN RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146535000 | ||||||||
| FaxNumber: | 3146534153 | ||||||||
| Practice Location | |||||||||
| Address1: | 11133 DUNN RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146535000 | ||||||||
| FaxNumber: | 3146534153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | KOESTERER | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3146535715 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | N | Transportation Services | Ambulance | 273R00000X | N | Hospital Units | Psychiatric Unit | 273Y00000X | N | Hospital Units | Rehabilitation Unit | 282N00000X | 4259 | MO | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 39 | 01 | BLUE CROSS OF IL | OTHER | 10490605 | 05 | MO | MEDICAID | 103187 | 01 | HEALTHLINK | OTHER | 260180 | 01 | MERCY HEALTHPLAN | OTHER | 5020061 | 01 | UNITED HEALTHCARE | OTHER | 39 | 01 | BLUE CROSS OF MO | OTHER | 769 | 01 | GHP | OTHER |