1619923240 NPI number — SSM REGIONAL HEALTH SERVICES

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 1619923240 NPI number — SSM REGIONAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM REGIONAL HEALTH SERVICES
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:
ST. MARYS CANCER SPECIALIST
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:
1619923240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1027
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65102-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-761-7246
Provider Business Mailing Address Fax Number:
573-761-6947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SAINT MARYS PLZ
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65101-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-761-0457
Provider Business Practice Location Address Fax Number:
573-761-0459
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAN CONIA
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-761-7000

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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