NPIMap

Organization Active NPI

SSM Cardinal Glennon Children's Hospital

Doing business as Cardinal Glennon Pediatric Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Saint Louis, MO
National Provider Identifier
1811074651
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
167-1 Issued in MO
Legal business name
SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
Doing business as
Cardinal Glennon Pediatric Surgery Center
Practice address
12700 Southfork Rd
Saint Louis, MO 63128-3201
Phone
(314) 543-5226
NPI assigned
Nov 1, 2006
Last updated
Nov 15, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM HEALTH CARE ST. LOUISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Authorized official

Name
Ms. Lynn L Boggs
Title
Evp/Coo
Phone
(314) 768-8032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 167-1 MO Primary

Addresses

Primary practice location

12700 Southfork Rd
Saint Louis, MO 63128-3201

Mailing address

1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone (314) 577-5600

Other identifiers 1

IdentifierTypeStateIssuer
507450302MedicaidMO

Other names 1

  • Cardinal Glennon Pediatric Surgery Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SSM Cardinal Glennon Children's Medical Center7 organizations share this tax ID, including this one
Part of
David a Kelley MD

Other organizations with this tax ID 6

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

Locations

12700 Southfork Rd
Ste 10
Saint Louis, MO 63128
Phone (314) 525-4949

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1811074651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-577-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 SOUTHFORK RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631283201",
            "telephone_number": "314-543-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM CARDINAL GLENNON CHILDREN'S HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM HEALTH CARE ST. LOUIS",
        "enumeration_date": "2006-11-01",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "BOGGS",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EVP/COO",
        "authorized_official_telephone_number": "314-768-8032",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "167-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507450302",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardinal Glennon Pediatric Surgery Center",
            "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 Nov 15, 2011; 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.