MEDICARE: SSM NEUROSCIENCES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1134589625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSM NEUROSCIENCES, INC.

Provider Business Mailing Address
First Line	:	1551 WALL ST
Second Line	:	SUITE 310
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3539
Country	:	US
Telephone Number	:	636-669-2268
Fax Number	:	314-209-8127

Provider Business Practice Location Address
First Line	:	225 PHYSICIANS PARK
Second Line	:	SUITE 102
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-3935
Country	:	US
Telephone Number	:	636-496-3900
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BARBARA PULLIAM
Credential	:
Telephone Number	:	636-669-2455

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	03/28/2016

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