Healthcare Provider Details

I. General information

NPI: 1215182001
Provider Name (Legal Business Name): SSM NEUROSCIENCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DEPAUL DR SUITE 830
BRIDGETON MO
63044
US

IV. Provider business mailing address

1551 WALL ST SUITE 310
SAINT CHARLES MO
63303-3539
US

V. Phone/Fax

Practice location:
  • Phone: 314-291-6556
  • Fax: 314-291-0184
Mailing address:
  • Phone: 636-669-2268
  • Fax: 636-669-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA PULLUM
Title or Position: BILLING MANAGER
Credential:
Phone: 636-669-2434