1295798403 NPI number — SSM HEALTH BUSINESSES

Table of content: (NPI 1295798403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295798403 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 MT VERNON
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:
1295798403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 GOOD SAMARITAN WAY STE 325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62864-2486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 MCPHERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62864-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-899-1621
Provider Business Practice Location Address Fax Number:
618-899-4744
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWEITZER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT PATIENT CARE SERVICE
Authorized Official Telephone Number:
608-778-2146

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1010902 , registered in the state of IL ; 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