SSM CARDINAL GLENNON CHILDREN'S HOSPITAL NPI 1811074651

NPI Information

NPI: 1811074651
Provider Name: SSM CARDINAL GLENNON CHILDREN'S HOSPITAL

Doing Business As: CARDINAL GLENNON PEDIATRIC SURGERY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
12700 SOUTHFORK RD
SAINT LOUIS, MO
ZIP 63128
Phone: (314) 543-5226
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SSM CARDINAL GLENNON CHILDREN'S HOSPITAL is an ambulatory surgical clinic center in Saint Louis, MO. SSM CARDINAL GLENNON CHILDREN'S HOSPITAL NPI is 1811074651. The provider is registered as an organization entity type.
The provider Is Doing Business As Cardinal Glennon Pediatric Surgery Center.

The provider's business location address is:

12700 SOUTHFORK RD
SAINT LOUIS, MO
ZIP 63128-201
Phone: (314) 543-5226

The provider's authorized official is Lynn L Boggs .
The authorized official title is Evp/coo and has the following contact phone number (314) 768-8032.

The enumeration date for this NPI number is 11/1/2006 and was last updated on 11/15/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	167-1	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	000040092	MEDICARE ID-TYPE UNSPECIFIED
2	=========003	MEDICAID	ILLINOIS
3	507450302	MEDICAID	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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