Healthcare Provider Details

I. General information

NPI: 1235209032
Provider Name (Legal Business Name): SSM HEALTH CARE ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DE PAUL DR
BRIDGETON MO
63044-2510
US

IV. Provider business mailing address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6000
  • Fax:
Mailing address:
  • Phone: 314-344-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006634
License Number StateMO

VIII. Authorized Official

Name: MR. SEAN HOGAN
Title or Position: PRESIDENT
Credential:
Phone: 314-344-7208