1871536037 NPI number — SSM ST. JOSEPH ENDOSCOPY CENTER, LLC

Table of content: (NPI 1871536037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871536037 NPI number — SSM ST. JOSEPH ENDOSCOPY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM ST. JOSEPH ENDOSCOPY CENTER, LLC
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 ENDOSCOPY CENTER
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:
1871536037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10176 CORPORATE SQUARE DR STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63132-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-989-6843
Provider Business Mailing Address Fax Number:
314-344-7281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4203 S CLOVER LEAF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-6452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-498-7400
Provider Business Practice Location Address Fax Number:
314-344-7281
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REWERTS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
SYSTEM VICE PRESIDENT FINANCE
Authorized Official Telephone Number:
314-989-6843

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com