1780763284 NPI number — SSM HEALTH CARE ST. LOUIS

Table of content: (NPI 1780763284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780763284 NPI number — SSM HEALTH CARE ST. LOUIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM HEALTH CARE ST. LOUIS
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 ST. MARY'S HOSPITAL - ST. LOUIS
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:
1780763284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6420 CLAYTON RD
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:
63117-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-768-8000
Provider Business Mailing Address Fax Number:
314-768-8011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 CLAYTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-768-8000
Provider Business Practice Location Address Fax Number:
314-768-8011
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAPERS
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-768-8052

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  383-13 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010326205 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540326204 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43065268100 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43065268140 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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