1598835308 NPI number — SSM HEALTH CARE ST. LOUIS

Table of content: (NPI 1598835308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598835308 NPI number — SSM HEALTH CARE ST. LOUIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM HEALTH CARE ST. LOUIS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SSM HEALTH DEPAUL HOSPITAL - ST. LOUIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598835308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12303 DE PAUL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-344-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12303 DE PAUL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-344-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARRISON
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-344-7210

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  414-11 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100411820A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149006105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1702471 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911294400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01400001 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540494101 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72101326 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33320 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010494102 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0553719 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200360100A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431704972401 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 756053200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 833203 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP43320 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07184768 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43170497200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431704972001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110401300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com