Healthcare Provider Details

I. General information

NPI: 1588601777
Provider Name (Legal Business Name): SSM REGIONAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 STATE ROUTE 5
TIPTON MO
65081-8441
US

IV. Provider business mailing address

PO BOX 1027
JEFFERSON CITY MO
65102-1027
US

V. Phone/Fax

Practice location:
  • Phone: 660-433-5541
  • Fax: 660-433-5717
Mailing address:
  • Phone: 573-681-3767
  • Fax: 573-761-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHASTA RENE MANUEL
Title or Position: REGIONAL VICE PRESIDENT FINANCE/CFO
Credential:
Phone: 405-272-7282