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SSM CARDINAL GLENNON CHILDRENS HOSPITAL NPI 1174577670


NPI Information

NPI: 1174577670
Provider Name: SSM CARDINAL GLENNON CHILDRENS HOSPITAL

Doing Business As: SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 26D2026531

Address:
1 SAINT ELIZABETH BLVD
O FALLON, IL
ZIP 62269
Phone: (618) 234-2120
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SSM CARDINAL GLENNON CHILDRENS HOSPITAL is a pediatrics in O Fallon, IL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SSM CARDINAL GLENNON CHILDRENS HOSPITAL NPI is 1174577670. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Ssm Health Cardinal Glennon Children's Hospital.

The provider's business location address is:

1 SAINT ELIZABETH BLVD
O FALLON, IL
ZIP 62269-099
Phone: (618) 234-2120

The provider's authorized official is Karen Rewerts .
The authorized official title is Vp Finance and has the following contact phone number (314) 989-2034.

The CLIA number assigned to this NPI record is 26D2026531 - other - hospital outpatient depar with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/19/2006 and was last updated on 9/30/2020.


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
12084P0800XPsychiatry & NeurologyPsychiatryNo
22085B0100XRadiologyBody ImagingNo
3103T00000XPsychologistNo
4104100000XSocial WorkerNo
5207ZC0500XPathologyCytopathologyNo
62080B0002XPediatricsObesity MedicineNo
7208000000XPediatricsYes

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 Other Provider Identifier Issuer
1540155801MEDICAIDMISSOURI

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: 5/5/2024

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