Organization Active NPI

Veterans Affairs Medical Center

  • Clinical Psychologist
  • Saint Louis, MO
National Provider Identifier
1063500494
Registry record updated Oct 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2006031019 Issued in MO
Legal business name
VETERANS AFFAIRS MEDICAL CENTER
Practice address
915 N Grand Blvd
Saint Louis, MO 63106-1621
Phone
(314) 652-4100
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Winters
Title
Business Manager
Phone
(314) 289-7676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 2006031019 MO Primary

Addresses

Primary practice location

915 N Grand Blvd
Saint Louis, MO 63106-1621

Mailing address

915 N Grand Blvd
Saint Louis, MO 63106-1621

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1063500494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "314-652-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VETERANS AFFAIRS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "WINTERS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "314-289-7676"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2006031019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.