Healthcare Provider Details

I. General information

NPI: 1427063072
Provider Name (Legal Business Name): SSM REGIONAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 HWY 5 SOUTH
TIPTON MO
65081-8253
US

IV. Provider business mailing address

PO BOX 40
TIPTON MO
65801
US

V. Phone/Fax

Practice location:
  • Phone: 660-433-5404
  • Fax: 660-433-5407
Mailing address:
  • Phone: 660-433-5404
  • Fax: 660-433-5407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2000146380
License Number StateMO

VIII. Authorized Official

Name: LIANNE TWYMAN
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 660-433-5404