Provider Demographics
NPI:1538177423
Name:CHRISTIAN HOSPITAL NORTHEAST NORTHWEST
Entity type:Organization
Organization Name:CHRISTIAN HOSPITAL NORTHEAST NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOESTERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-653-5715
Mailing Address - Street 1:11133 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6119
Mailing Address - Country:US
Mailing Address - Phone:314-653-5000
Mailing Address - Fax:314-653-4153
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6119
Practice Address - Country:US
Practice Address - Phone:314-653-5000
Practice Address - Fax:314-653-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO425-9273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
769OtherGHP
39OtherBLUE CROSS OF IL
5020061OtherUNITED HEALTHCARE
103187OtherHEALTHLINK
39OtherBLUE CROSS OF MO
MO10490605Medicaid
5020061OtherUNITED HEALTHCARE
=========OtherCIGNA
103187OtherHEALTHLINK
=========OtherAETNA
MO10490605Medicaid