Healthcare Provider Details

I. General information

NPI: 1043450711
Provider Name (Legal Business Name): SSM REGIONAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 MISSION DR SUITE 210
JEFFERSON CITY MO
65109-9508
US

IV. Provider business mailing address

7655 SOLUTIONS CTR
CHICAGO IL
60677-7006
US

V. Phone/Fax

Practice location:
  • Phone: 573-681-3000
  • Fax: 573-659-2503
Mailing address:
  • Phone: 557-203-1551
  • Fax: 314-989-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SHASTA RENE MANUEL
Title or Position: REGIONAL VICE PRESIDENT FINANCE/CFO
Credential:
Phone: 405-272-7282