CARDINAL GLENNON PEDIATRIC SURGERY CENTER – NPI #1811074651
Clinic/Center

CARDINAL GLENNON PEDIATRIC SURGERY CENTER is an AHC clinic located in SAINT LOUIS, MO. NPPES has assigned the NPI number 1811074651 to CARDINAL GLENNON PEDIATRIC SURGERY CENTER on November 01, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “CARDINAL GLENNON PEDIATRIC SURGERY CENTER” is a dba name, the actual legal business name for this organization is SSM CARDINAL GLENNON CHILDREN'S HOSPITAL. The primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

The NPI profile was previously updated about 15 years ago on Nov 15, 2011. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CARDINAL GLENNON PEDIATRIC SURGERY CENTER below.

NPI Profile for
SSM CARDINAL GLENNON CHILDREN'S HOSPITAL

NPI Number
1811074651
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
Doing Business As (dba): CARDINAL GLENNON PEDIATRIC SURGERY CENTER
Primary location
12700 SOUTHFORK RD
SAINT LOUIS, MO 63128-3201
Phone: (314) 543-5226 Fax:
Mailing address
1465 S GRAND BLVD
SAINT LOUIS, MO 63104-1003
Phone: (314) 577-5600 Fax:
Organization Subpart
Yes - CARDINAL GLENNON PEDIATRIC SURGERY CENTER is subpart of another organization.
Authorized Official
LYNN BOGGS
EVP/COO
Phone: (314) 768-8032
Updated
Identifiers

Identifiers for CARDINAL GLENNON PEDIATRIC SURGERY CENTER

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMO507450302
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)
MO 167-1

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.