Healthcare Provider Details

I. General information

NPI: 1275265167
Provider Name (Legal Business Name): SSM HEALTH CARE ST LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3662 PARK AVE STE 155
SAINT LOUIS MO
63110-2512
US

IV. Provider business mailing address

3662 PARK AVE STE 155
SAINT LOUIS MO
63110-2512
US

V. Phone/Fax

Practice location:
  • Phone: 855-847-3553
  • Fax: 855-847-3558
Mailing address:
  • Phone: 833-354-2223
  • Fax: 833-354-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SPENCER
Title or Position: V.P. PHARMACY SERVICES
Credential:
Phone: 314-989-2588