Healthcare Provider Details

I. General information

NPI: 1952574469
Provider Name (Legal Business Name): SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DE PAUL DR SUITE 445
BRIDGETON MO
63044-2510
US

IV. Provider business mailing address

1035 BELLEVUE AVE SUITE 502
SAINT LOUIS MO
63117-1854
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-8269
  • Fax:
Mailing address:
  • Phone: 314-647-8269
  • Fax: 314-646-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK RENKEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 314-989-2160