George Fleming Glenn, CCP

Primary specialty

PerfusionistTaxonomy code 242T00000X

License

199140713 Issued in MO

Practice address

7220 N Lindbergh Blvd
Hazelwood, MO 63042-2019

Phone

(314) 838-8000

Fax

(314) 838-8304

NPI assigned

Jan 2, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388620800000",
    "number": "1730500141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 PARTRIDGE PL",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620255512",
            "telephone_number": "314-443-1024",
            "fax_number": "314-656-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7220 N LINDBERGH BLVD",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630422019",
            "telephone_number": "314-838-8000",
            "fax_number": "314-838-8304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "GEORGE",
        "middle_name": "FLEMING",
        "credential": "CCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-02",
        "last_updated": "2014-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "MO",
            "license": "199140713",
            "primary": true
        },
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "IL",
            "license": "214.000313",
            "primary": false
        },
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": "WI",
            "license": "125-18",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Perfusionist in Hazelwood, MO
• Providers in Hazelwood, MO by specialty
• Perfusionist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; 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.