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General NPI Number Information
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NPI Number | 1447633557
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Entity Type | Organization
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Legal Business Name | SSM MEDICAL GROUP INC.
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 400 1ST CAPITOL DR SUITE 100
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City | SAINT CHARLES
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State | MO
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Zip | 63301
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Country | US
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Telephone | 636-332-8455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 955534
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City | SAINT LOUIS
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State | MO
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Zip | 63195-5534
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Country | US
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Telephone | 636-498-5973
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Fax |
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Authorized Official
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Title or Position | VP FINANCIAL OPERATIONS
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Name | KAREN REWERTS
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Credential |
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Telephone | 314-989-2034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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