Provider Demographics
NPI:1992727663
Name:ST. LOUIS CHILDREN'S HOSPITAL
Entity type:Organization
Organization Name:ST. LOUIS CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-747-4297
Mailing Address - Street 1:1 CHILDRENS PL STE 3S-36
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:144-546-0443
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6000
Practice Address - Fax:314-454-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PP0204X, 273R00000X, 282N00000X, 283Q00000X, 341600000X
MO324-26282NC2000X
MO324-29282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
No273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No283Q00000XHospitalsPsychiatric Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA936377Medicaid
MO203559307Medicaid
MS95348Medicaid
103176OtherHEALTH LINK
KY1440650Medicaid
518802OtherAETNA
MO540930906Medicaid
FL901450100Medicaid
OK100693290AMedicaid
MO203530209Medicaid
MO010930907Medicaid
AR112148105Medicaid
17268OtherGHP AND CMR
LA1737518Medicaid
167OtherMISSOURI BLUE CROSS
5010193OtherUNITED HEALTHCARE
ALHOS330INMedicaid
IA936377Medicaid
MS95348Medicaid