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General NPI Number Information
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NPI Number | 1902281181
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Entity Type | Organization
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Legal Business Name | SSM-SLUH INC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 3635 VISTA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2539
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Country | US
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Telephone | 314-577-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 CORPORATE LAKE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1716
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Country | US
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Telephone | 314-989-3524
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Fax | 314-989-3695
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Authorized Official
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Title or Position | REGIONAL CFO - FINANCIAL STRATEGY
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Name | MR. TIMOTHY BULLER
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Credential |
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Telephone | 314-989-2173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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