Healthcare Provider Details

I. General information

NPI: 1649459215
Provider Name (Legal Business Name): SSM MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 THE LEGENDS PKWY SUITE 100
EUREKA MO
63025-3821
US

IV. Provider business mailing address

7980 CLAYTON RD SUITE 202
SAINT LOUIS MO
63117-1354
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-7888
  • Fax: 636-938-7171
Mailing address:
  • Phone: 314-951-5368
  • Fax: 314-951-5328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LESA M SCHNARR
Title or Position: DIRECTOR
Credential:
Phone: 314-951-5330