Organization
SSM CARDINAL GLENNON CHILDRENS HOSPITAL
Active
Parent organization
SSM CARDINAL GLENNON CHILDRENS HOSPITAL
Other names
SSM Health Cardinal Glennon Children's Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM CARDINAL GLENNON CHILDRENS HOSPITAL
Authorized official
KAREN REWERTS (VP FINANCE)
(314) 989-2034
Entity
Organization
Contact information
Practice address
1 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1099
(618) 234-2120
Mailing address
1145 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-2907
(314) 989-6843
(314) 989-7281
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
207ZC0500X
Cytopathology Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080B0002X
Pediatric Obesity Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2085B0100X
Body Imaging Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
540155801
—
MO
Enumeration date
05/19/2006
Last updated
09/30/2020
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