1982646980 NPI number — SSM ST. JOSEPH HEALTH CENTER

Table of content: JON LEE NEUMANN M.D. (NPI 1093735763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982646980 NPI number — SSM ST. JOSEPH HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM ST. JOSEPH HEALTH CENTER
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:
THE IMAGING CENTER AT ST. JOSEPH MEDICAL PARK
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:
1982646980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1836 LACKLAND HILL PKWY
Provider Second Line Business Mailing Address:
ATTNT: CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63146-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-989-0300
Provider Business Mailing Address Fax Number:
636-498-7420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1475 KISKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63304-8781
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:
636-498-7420
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-989-2072

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)

  • Identifier: P00243976 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00137824 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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