1851312714 NPI number — SSM MEDICAL GROUP

Table of content: (NPI 1851312714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851312714 NPI number — SSM MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM MEDICAL GROUP
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. LOUIS MEDICAL ASSOCIATES
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:
1851312714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7980 CLAYTON RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63117-1354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-951-5368
Provider Business Mailing Address Fax Number:
314-951-5238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 SUNSET OFFICE DR
Provider Second Line Business Practice Location Address:
SUITE C-100
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63127-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-238-9100
Provider Business Practice Location Address Fax Number:
314-238-9110
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PIERSON
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
314-238-9100

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 501906101 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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