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General NPI Number Information
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NPI Number | 1831288869
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Entity Type | Organization
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Legal Business Name | SSM REGIONAL HEALTH SERVICES
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 2511 W EDGEWOOD DR SUITE D
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-5869
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Country | US
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Telephone | 573-761-0304
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Fax | 573-635-0726
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Provider Business Mailing Address
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Address Line | PO BOX 1027
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City | JEFFERSON CITY
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State | MO
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Zip | 65102-1027
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Country | US
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Telephone | 573-681-3767
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Fax | 573-681-3593
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Authorized Official
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Title or Position | REGIONAL VICE PRESIDENT FINANCE/CFO
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Name | SHASTA RENE MANUEL
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Credential |
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Telephone | 405-272-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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