Provider Demographics
NPI:1871132449
Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
Entity type:Organization
Organization Name:WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:143-273-0770
Mailing Address - Street 1:660 SOUTH EUCLID AVENUE
Mailing Address - Street 2:CAMPUS BOX 8115
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-362-7395
Mailing Address - Fax:314-362-7522
Practice Address - Street 1:19 WOLF CREEK DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2355
Practice Address - Country:US
Practice Address - Phone:618-235-3687
Practice Address - Fax:314-362-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty