Healthcare Provider Details

I. General information

NPI: 1407740061
Provider Name (Legal Business Name): SSM DEPAUL HEALTH CENTER FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

12255 DEPAUL DRIVE SUITE 705
BRIDGETON MO
63044
US

V. Phone/Fax

Practice location:
  • Phone: 324-344-6000
  • Fax:
Mailing address:
  • Phone: 314-344-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: HOLLY HOPKINS
Title or Position: PODIATRIC RESIDENCY MANAGER
Credential:
Phone: 314-344-6000