Healthcare Provider Details

I. General information

NPI: 1275586174
Provider Name (Legal Business Name): SSM HEALTH CARE ST LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BOWLES AVENUE
FENTON MO
63026
US

IV. Provider business mailing address

12800 CORPORATE HILL DR
SAINT LOUIS MO
63131-1845
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-2502
  • Fax:
Mailing address:
  • Phone: 557-203-1486
  • Fax: 314-344-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE M STRAUSS
Title or Position: PROVIDER ENROLLMENT COORDINATOR
Credential: PROVIDER ENROLLMENT
Phone: 557-203-1486