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Organization
SSM REGIONAL HEALTH SERVICES
Active
Organization
SSM REGIONAL HEALTH SERVICES
Active
Parent organization
SSM REGIONAL HEALTH SERVICES
Other names
SSM Health Medical Group - Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM REGIONAL HEALTH SERVICES
Authorized official
SHASTA RENE MANUEL (REGIONAL VICE PRESIDENT FINANCE/CFO)
(405) 272-7282
Entity
Organization
Contact information
Practice address
2511 W EDGEWOOD DR STE G, JEFFERSON CITY, MO 65109-5869
(573) 761-0458
(573) 634-3137
Mailing address
7655 SOLUTIONS CTR, CHICAGO, IL 60677-7006
(557) 203-1551
(314) 989-6721
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/08/2007
Last updated
12/16/2025
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