Healthcare Provider Details

I. General information

NPI: 1649426768
Provider Name (Legal Business Name): SSM ST. JOSEPH HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD
SAINT CHARLES MO
63304-8781
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY ATTN CREDENTIALING DEPARTMENT
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 636-498-7400
  • Fax: 636-498-7420
Mailing address:
  • Phone: 314-989-0300
  • Fax: 636-498-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SHERLYN HAILSTONE
Title or Position: PRESIDENT
Credential:
Phone: 636-947-5076