# ST LOUIS UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SLUCARE DEPT OF PEDIATRIC SPORT MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336368034
- **Authorized official:** ALYCE LANXON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (314) 977-6828

## Contact information

- **Practice address:** 1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
- **Practice address phone:** (314) 577-5643
- **Mailing address:** 3545 LINDELL BLVD FL 3, SAINT LOUIS, MO 63103-1020
- **Mailing address phone:** (314) 977-6828

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080S0010X | Pediatric Sports Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 09/21/2021