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General NPI Number Information
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NPI Number | 1275781288
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Entity Type | Organization
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Legal Business Name | SSM MEDICAL GROUP
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 1011 BOWLES AVE SUITE 300
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City | FENTON
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State | MO
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Zip | 63026-2387
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Country | US
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Telephone | 636-496-5000
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Fax | 636-496-5055
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Provider Business Mailing Address
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Address Line | 10777 SUNSET OFFICE DR SUITE 310
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1019
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Country | US
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Telephone | 314-822-5900
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Fax | 314-822-5919
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAMES E BIESER
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Credential |
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Telephone | 314-822-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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