Healthcare Provider Details

I. General information

NPI: 1154376465
Provider Name (Legal Business Name): SSM ST. JOSEPH HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD SUITE 190
SAINT CHARLES MO
63304-8781
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 636-498-7800
  • Fax: 636-498-7819
Mailing address:
  • Phone: 314-989-0300
  • Fax: 314-810-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN JOHNSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 314-989-2072