# SSM MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Practice of South County
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275781288
- **Authorized official:** JAMES E BIESER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (314) 822-5900

## Contact information

- **Practice address:** 1011 BOWLES AVE, SUITE 300, FENTON, MO 63026-2387
- **Practice address phone:** (636) 496-5000
- **Practice address fax:** (636) 496-5055
- **Mailing address:** 10777 SUNSET OFFICE DR, SUITE 310, SAINT LOUIS, MO 63127-1019
- **Mailing address phone:** (314) 822-5900
- **Mailing address fax:** (314) 822-5919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2008
- **Last updated:** 07/08/2009