Healthcare Provider Details

I. General information

NPI: 1871536037
Provider Name (Legal Business Name): SSM ST. JOSEPH ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 S CLOVER LEAF
ST. LOUIS MO
63376-6452
US

IV. Provider business mailing address

10176 CORPORATE SQUARE DR STE 110
SAINT LOUIS MO
63132-2924
US

V. Phone/Fax

Practice location:
  • Phone: 636-498-7400
  • Fax: 314-344-7281
Mailing address:
  • Phone: 314-989-6843
  • Fax: 314-344-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN REWERTS
Title or Position: SYSTEM VICE PRESIDENT FINANCE
Credential: CFO
Phone: 314-989-6843