Healthcare Provider Details

I. General information

NPI: 1134400484
Provider Name (Legal Business Name): SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE SUITE 200
SAINT LOUIS MO
63117-1851
US

IV. Provider business mailing address

12855 N 40 DR SUITE 300
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-6450
  • Fax: 314-645-2560
Mailing address:
  • Phone: 314-880-6100
  • Fax: 314-997-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK E RENKEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 314-989-2160