SSM CARDINAL GLENNON CHILDRENS HOSPITAL


Address: 4100 Forest Park Ave Ste 101a, Saint Louis, MO 63108-2885
Phone: 3145775627

SSM CARDINAL GLENNON CHILDRENS HOSPITAL (NPI# 1073568226) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1073568226
Entity Type Organization
Organization Name SSM CARDINAL GLENNON CHILDRENS HOSPITAL
Other Organization Name SSM HEALTH CARDINAL GLENNON PEDIATRICS
Practice Address 4100 Forest Park Ave Ste 101a
Saint Louis
MO 63108-2885
Mailing Address 1145 Corporate Lake Drive
Saint Louis
MO 63132-2907
Practice Telephone 3145775627
Practice Fax Number 3143447281
Mailing Telephone 3149896843
Mailing Fax Number 3143447281
Enumeration Date 2006-05-24
Last Update Date 2019-03-21
Authorized Official Name MRS. KAREN REWERTS (SYSTEM VICE PRESIDENT FINANCE)
Authorized Official Telephone 3149896843
Authorized Official Credential CFO
Is Organization Subpart Y
Parent Organization Name SSM CARDINAL GLENNON CHILDREN'S HOSPITAL

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208000000X Pediatrics Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
MO 505459107 05
CLIA 26D2159157 01
MO 540155801 05

Other Provider/Organization Names

Other Name Type Code
SSM Health Cardinal Glennon Pediatrics Doing Business As Name - Organization

Provider Secondary Practice Location

Address Telephone Number Fax Number
12255 Depaul Drive Ste 300, Bridgeton, MO 630442512 3143446021
6800 State Route 162, Maryville, IL 620622512 6182885711
4129 North Highway 67, Florissant, MO 630342512 3143556390 3143552417
9553 Lackland Road, St.louis, MO 631142512 3144297733 3144293194
12303 De Paul Dr, Bridgeton, MO 630442512 3143446000 3143446840
3878 Pershall Rd, Ferguson, MO 631351246 3143446021 3143447281
511 Ashland Ave Ste A, Warrenton, MO 633831065 6364560572
132 Professional Pkwy, Troy, MO 633792823 6364625437

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1609969880 Ssm Cardinal Glennon Childrens Hospital Pharmacy 1465 S Grand Blvd, Saint Louis, MO 63104-1003 2006-10-02
1174577670 Ssm Cardinal Glennon Childrens Hospital Psychiatry & Neurology 1 Saint Elizabeth Blvd, O Fallon, IL 62269-1099 2006-05-19

Office Location

Street Address 4100 FOREST PARK AVE STE 101A
City SAINT LOUIS
State MO
Zip Code 63108-2885

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1346851474 Nigel Austen Thomas Cook Social Worker 4050 West Pine Blvd. Apt. 4118, St. Louis, MO 63108 2020-08-12
1467070011 C2n Diagnostics, LLC Clinical Medical Laboratory 20 South Sarah Street, Saint Louis, MO 63108 2020-07-10
1609414358 Kaylee Breitenbucher Occupational Therapist 4444 Forest Park Avenue, Msc 8505-94-01, St. Louis, MO 63108 2019-12-12
1114419546 Activangels Home Health Home Health 4625 Lindell Blvd Ste 304, Saint Louis, MO 63108 2018-06-01
1215427349 Heart To Heart Consolidated Home Care Service LLC Home Health 4625 Lindell Blvd Ste 200, Saint Louis, MO 63108 2018-05-15
1447755905 Erin Virginia Adams Student in an Organized Health Care Education/Training Program 4355 Maryland Ave Apt 116, Saint Louis, MO 63108 2018-03-27
1033621172 Roots Healthcare and Homes In Home Supportive Care 4300 Enright Ave, St. Louis, MO 63108 2017-10-30
1336661719 House of Destiny Adult Day Care LLC Clinic/Center 4507 Olive Street, St Louis, MO 63108 2017-07-07
1003338492 Khin Min Thu Social Worker 4236 Lindell Blvd., Suite 200, St Louis, MO 63108 2017-07-07
1679093967 Together We Can Home Healthcare Services LLC Home Health 4144 Lindell Blvd Suite 221, Saint Louis, MO 63108 2017-06-27
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Taxonomy Information

Taxonomy Code 208000000X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics

Taxonomy Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio
- Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1538786413 Melissa An Pediatrics 1 Childrens Pl Ste 3s36, Saint Louis, MO 63110-1002 2020-06-26
1538795547 Virtualnicu Pediatrics 10 Warridge Dr, Saint Louis, MO 63124-1166 2020-03-21
1174082887 Kristen Steinmeyer Pediatrics 714 Peace Haven Ct, Saint Louis, MO 63125-5404 2019-03-13
1487149498 Jessica Sims Pediatrics 1 Childrens Pl Ste 3s34, Saint Louis, MO 63110-1002 2018-06-22
1356835342 Jerome Michael Molleston Pediatrics 1 Childrens Pl Cb8116, Saint Louis, MO 63110-1081 2018-06-21
1598259566 Kylie Bushroe Pediatrics 1 Childrens Pl Ste 3n18, Saint Louis, MO 63110-1081 2018-06-21
1710492228 Ideal Pediatric Wellness, LLC Pediatrics 10007 Kennerly Rd Ste C, Saint Louis, MO 63128-2179 2017-12-06
1578083424 Michael Quinn Pediatrics Wusm Peds Infectious Diseases, 1 Childrens Pl Cb 8116, Saint Louis, MO 63110-1002 2017-06-21
1205367612 Anchal Sethi Pediatrics 1234 S Kingshighway Blvd Ste 1200, Saint Louis, MO 63110-2170 2017-03-27
1831541895 Lila Sarah Wahidi Nolan Pediatrics Wusm Peds Newborn Medicine, 1 Childrens Pl Cb 8116, Saint Louis, MO 63110 2016-07-01
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Competitor

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City SAINT LOUIS
Zip Code 63108

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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