Healthcare Provider Details

I. General information

NPI: 1992880397
Provider Name (Legal Business Name): SSM MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE AVE SUITE 300
SAINT LOUIS MO
63117-1818
US

IV. Provider business mailing address

7980 CLAYTON RD SUITE 202
SAINT LOUIS MO
63117-1354
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-6178
  • Fax:
Mailing address:
  • Phone: 314-951-5368
  • Fax: 314-951-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LESA SCHNARR
Title or Position: DIRECTOR
Credential:
Phone: 314-951-5330