# SSM REGIONAL HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SSM REGIONAL HEALTH SERVICES
- **Other names:** Center for Plastics & Restorative Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679510861
- **Legal business name:** SSM REGIONAL HEALTH SERVICES
- **Authorized official:** BRENT VAN CONIA (PRESIDENT)
- **Authorized official phone:** (573) 761-7000

## Contact information

- **Practice address:** 200 SAINT MARYS PLZ, SUITE 201, JEFFERSON CITY, MO 65101-1604
- **Practice address phone:** (573) 632-4325
- **Practice address fax:** (573) 659-2503
- **Mailing address:** PO BOX 1027, JEFFERSON CITY, MO 65102-1027
- **Mailing address phone:** (573) 632-4325
- **Mailing address fax:** (573) 761-2006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/31/2006
- **Last updated:** 12/13/2007