Organization
SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
Active
Parent organization
SSM HEALTH CARE ST. LOUIS
Other names
Cardinal Glennon Pediatric Surgery Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM HEALTH CARE ST. LOUIS
Authorized official
MS. LYNN L BOGGS (EVP/COO)
(314) 768-8032
Entity
Organization
Contact information
Practice address
12700 SOUTHFORK RD, SAINT LOUIS, MO 63128-3201
(314) 543-5226
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5600
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
167-1
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507450302
—
MO
Enumeration date
11/01/2006
Last updated
11/15/2011
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