# ST.. LOUIS UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SLUCare Dept of F&CM Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780948018
- **Authorized official:** ALYCE LANXON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (314) 977-6828

## Contact information

- **Practice address:** 1225 SOUTH GRAND, 2L, DOOR 5, ST LOUIS, MO 63104
- **Practice address phone:** (314) 977-4700
- **Mailing address:** 3545 LINDELL BLVD FL 3, SAINT LOUIS, MO 63103-1020
- **Mailing address phone:** (314) 977-6828
- **Mailing address fax:** (314) 977-6872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/02/2012
- **Last updated:** 09/21/2021