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General NPI Number Information
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NPI Number | 1043450711
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Entity Type | Organization
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Legal Business Name | SSM REGIONAL HEALTH SERVICES
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 2505 MISSION DR SUITE 210
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-9508
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Country | US
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Telephone | 573-681-3000
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Fax | 573-659-2503
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Provider Business Mailing Address
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Address Line | 7655 SOLUTIONS CTR
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City | CHICAGO
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State | IL
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Zip | 60677-7006
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Country | US
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Telephone | 557-203-1551
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Fax | 314-989-6721
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Authorized Official
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Title or Position | REGIONAL VICE PRESIDENT FINANCE/CFO
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Name | SHASTA RENE MANUEL
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Credential |
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Telephone | 405-272-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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