Organization
BJC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD JIM VREDENBURGH III BSN (STAFF NURSE)
(573) 268-2749
Entity
Organization
Contact information
Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6163
(314) 653-5000
Mailing address
92 ROTTINGHAM CT, EDWARDSVILLE, IL 62025-3685
(573) 268-2749
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
041.392442
IL
282N00000X
General Acute Care Hospital
Primary
2001004428
MO
Other
Enumeration date
02/11/2016
Last updated
02/11/2016
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