1053440511 NPI number — SSM HEALTH BUSINESSES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053440511 NPI number — SSM HEALTH BUSINESSES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM HEALTH BUSINESSES
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 AT HOME HOME HEALTH OKLAHOMA
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:
1053440511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12312 OLIVE BLVD STE 400
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:
63141-6448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-989-2500
Provider Business Mailing Address Fax Number:
314-989-3901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 NW 11TH ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73103-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-231-2992
Provider Business Practice Location Address Fax Number:
405-231-2993
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRUEGER
Authorized Official First Name:
KARI
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL VP OF FINANCE
Authorized Official Telephone Number:
608-260-3567

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 260494505 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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