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General NPI Number Information
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NPI Number | 1255470050
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Entity Type | Organization
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Legal Business Name | PHYSICIANS OF SSM ST LOUIS
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 300 MEDICAL PLZ SUITE 230
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1481
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Country | US
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Telephone | 636-625-1111
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Fax | 636-625-8566
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Provider Business Mailing Address
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Address Line | 300 MEDICAL PLZ SUITE 230
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1481
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Country | US
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Telephone | 636-625-1111
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Fax | 636-625-8566
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Authorized Official
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Title or Position | VICE PRES OF PATIENT FINANCIAL SERV
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Name | MRS. DIANE BARRY
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Credential |
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Telephone | 314-989-2180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2006016942
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License Number State | MO
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