NPIMap

Organization Active NPI

St Louis University

  • Pediatric Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1114990454
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
Legal business name
ST LOUIS UNIVERSITY
Practice address
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone
(314) 977-6828
NPI assigned
Feb 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Authorized official

Name
Mrs. Alyce Lanxon
Title
Executive Director
Phone
(314) 977-6828

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0120X Primary

Addresses

Primary practice location

1465 S Grand Blvd
Saint Louis, MO 63104-1003

Mailing address

1831 Chestnut St Ste 650
Saint Louis, MO 63103-2236
Phone (314) 977-6828

Other names 1

  • SLUCare Department of Pediatric Surgery Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1034 S Brentwood Blvd
Saint Louis, MO 63117
Phone (314) 646-7584

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561075200000",
    "number": "1114990454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 CHESTNUT ST STE 650",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032236",
            "telephone_number": "314-977-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-977-6828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LOUIS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2019-06-21",
        "status": "A",
        "authorized_official_last_name": "LANXON",
        "authorized_official_first_name": "ALYCE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-977-6828",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLUCare Department of Pediatric Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SLUCare Department of Pediatric Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 21, 2019; 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.