1053440511 NPI number — SSM HEALTH BUSINESSES

Table of content: (NPI 1053440511)

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:
Provider Other Organization Name Type Code:
6
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".




Copyright © 2007-2025 www.npivalidator.com