Basic Information
| Provider Information | |||||||||
| NPI: | 1710909486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LOUIS CHILDRENS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHILDRENS PL | ||||||||
| Address2: | ADMINISTRATION, SUITE 3S-36 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144546044 | ||||||||
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| Address1: | 1 CHILDRENS PL | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144546000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCKEE | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3144546044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 324-22 | MO | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 167 | 01 | MISSOURI BLUE CROSS | OTHER | 936377 | 05 | IA | MEDICAID | HOS330IN | 05 | AL | MEDICAID | 103176 | 01 | HEALTH LINK | OTHER | 112148105 | 05 | AR | MEDICAID | 100693290A | 05 | OK | MEDICAID | 1440650 | 05 | KY | MEDICAID | 95348 | 05 | MS | MEDICAID | 1737518 | 05 | LA | MEDICAID | 5010193 | 01 | UNITED HEALTHCARE | OTHER | 518802 | 01 | AETNA | OTHER | 901450100 | 05 | FL | MEDICAID | 10930907 | 05 | MO | MEDICAID | 17268 | 01 | GHP AND CMR | OTHER |