# SSM ST. CHARLES CLINIC MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SSM Health Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811932973
- **Authorized official:** MS. LAURA PULLUM (BILLING MANAGER)
- **Authorized official phone:** (636) 669-2434

## Contact information

- **Practice address:** 1551 WALL ST, SUITE 400, SAINT CHARLES, MO 63303-3539
- **Practice address phone:** (636) 669-2350
- **Practice address fax:** (636) 669-2221
- **Mailing address:** 1551 WALL ST, SUITE 310, SAINT CHARLES, MO 63303-3539
- **Mailing address phone:** (636) 669-2268
- **Mailing address fax:** (314) 209-8127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 06/20/2006
- **Last updated:** 01/15/2016