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General NPI Number Information
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NPI Number | 1134400484
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Entity Type | Organization
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Legal Business Name | SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 1027 BELLEVUE AVE SUITE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1851
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Country | US
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Telephone | 314-645-6450
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Fax | 314-645-2560
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR SUITE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-880-6100
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Fax | 314-997-6033
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MARK E RENKEN
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Credential |
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Telephone | 314-989-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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