=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093718900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SSM HEALTH BUSINESSES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2005
-----------------------------------------------------
Last Update Date | 08/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 MCPHERSON AVE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62864-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-899-1624
-----------------------------------------------------
Fax | 615-899-4744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 MCPHERSON AVE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62864-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT PATIENT CARE SERVICE
-----------------------------------------------------
Name | LISA SCHWEITZER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 608-778-2146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 2002665
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------