OrganizationActive
St Louis University
NPI 1336368034 · Pediatric Sports Medicine Physician · Saint Louis, MO
Provider details
- NPI number
- 1336368034
- Entity type
- Organization
- Primary specialty
- Pediatric Sports Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Alyce Lanxon, Executive Director(314) 977-6828
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone: (314) 577-5643
Approximate (ZIP-level) locationGet directions
Mailing address
3545 Lindell Blvd Fl 3
Saint Louis, MO 63103-1020
Other names (DBA / former)
- Doing business as
- Slucare Dept of Pediatric Sport Medicine
- Doing business as
- Slucare Dept of Pediatric Sport Medicine
Registry dates
- Enumerated
- 2007-04-24
- Last updated
- 2021-09-21
- Certified
- 2021-09-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.