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General NPI Number Information
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NPI Number | 1851833305
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Entity Type | Organization
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Legal Business Name | SSM HEALTHCARE
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 500 MEDICAL DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-3421
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Country | US
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Telephone | 636-327-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1511
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City | LAKE SHERWOOD
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State | MO
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Zip | 63357-8511
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Country | US
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Telephone | 636-398-0110
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. PAUL GEERLING
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Credential | LPC
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Telephone | 636-327-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 003579
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License Number State | MO
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