Healthcare Provider Details

I. General information

NPI: 1346237112
Provider Name (Legal Business Name): SSM HEALTH CARE ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DEPAUL DR.
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

12303 DEPAUL DR.
BRIDGETON MO
63044-2512
US

V. Phone/Fax

Practice location:
  • Phone: 314-209-8814
  • Fax: 314-209-8823
Mailing address:
  • Phone: 314-209-8814
  • Fax: 314-209-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number41410
License Number StateMO

VIII. Authorized Official

Name: MR. ELLIS D. HAWKINS
Title or Position: HOSPITAL PRESIDENT
Credential:
Phone: 314-344-7210