Provider Demographics
NPI:1447302161
Name:ST. LOUIS CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:ST. LOUIS CHILDREN'S HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-996-8401
Mailing Address - Street 1:PO BOX 504225
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:314-454-6250
Mailing Address - Fax:314-454-4006
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:LS 2
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6250
Practice Address - Fax:314-454-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO324-2261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010930907Medicaid