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General NPI Number Information
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NPI Number | 1760456743
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Entity Type | Organization
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Legal Business Name | SSM DEPAUL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 2024 DORSETT VLG
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2208
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Country | US
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Telephone | 314-590-0550
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Fax | 314-590-0560
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Provider Business Mailing Address
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Address Line | 1551 WALL ST SUITE 310
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3539
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Country | US
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Telephone | 636-669-2268
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Fax | 314-209-8127
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. LAURA L PULLUM
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Credential |
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Telephone | 636-669-2434
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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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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease 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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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