NPIMap

Organization Active NPI

St Louis University

  • Sports Medicine (Family Medicine) Physician
  • St Louis, MO
National Provider Identifier
1306120183
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
ST LOUIS UNIVERSITY
Practice address
1225 South Grand
2L, Door 5
St Louis, MO 63104-6310
Phone
(314) 977-4440
NPI assigned
Sep 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X Primary

Addresses

Primary practice location

1225 South Grand
2L, Door 5
St Louis, MO 63104-6310

Mailing address

3545 Lindell Blvd FL 3
Saint Louis, MO 63103-1020
Phone (314) 977-6828

Other practice location 1

1755 S Grand Blvd
Saint Louis, MO 63104-1540
Phone (314) 256-3850

Other names 1

  • SLUCare Dept of FCM Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Slucare Dept of Neuro S16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

3691 Rutger St
Saint Louis, MO 63110
Phone (314) 268-4101

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1306120183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 LINDELL BLVD FL 3",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031020",
            "telephone_number": "314-977-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 SOUTH GRAND",
            "address_2": "2L, DOOR 5",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631046310",
            "telephone_number": "314-977-4440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1755 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041540",
            "country_code": "US",
            "telephone_number": "314-256-3850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST LOUIS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-28",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "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"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLUCare Dept of FCM Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SLUCare Dept of FCM Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.