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General NPI Number Information
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NPI Number | 1235209032
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Entity Type | Organization
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Legal Business Name | SSM HEALTH CARE ST. LOUIS
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 12255 DE PAUL DR
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City | BRIDGETON
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State | MO
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Zip | 63044-2510
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Country | US
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Telephone | 314-344-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 12303 DE PAUL DR
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City | BRIDGETON
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State | MO
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Zip | 63044-2512
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Country | US
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Telephone | 314-344-6000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SEAN HOGAN
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Credential |
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Telephone | 314-344-7208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 006634
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License Number State | MO
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