NPIMap

Organization Active NPI

St Louis University

  • Pediatric Dermatology Physician
  • Saint Louis, MO
National Provider Identifier
1346461241
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
Legal business name
ST LOUIS UNIVERSITY
Practice address
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone
(314) 268-4010
NPI assigned
May 1, 2007
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
Pediatric Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NP0225X Primary

Addresses

Primary practice location

1465 S Grand Blvd
Saint Louis, MO 63104-1003

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) 256-3400

Other names 1

  • SLUCARE DEPT OF PEDIATRIC DERMATOLOGY Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1346461241",
    "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": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-268-4010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1755 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041540",
            "country_code": "US",
            "telephone_number": "314-256-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST LOUIS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "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": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLUCARE DEPT OF PEDIATRIC DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SLUCARE DEPT OF PEDIATRIC DERMATOLOGY",
            "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 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.