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Organization
SSM DEPAUL MEDICAL GROUP, INC.
Active
Organization
SSM DEPAUL MEDICAL GROUP, INC.
Active
Parent organization
SSM DEPAUL MEDICAL GROUP
Other names
DePaul Medical Group at Cross Keys
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM DEPAUL MEDICAL GROUP
Authorized official
MS. LAURA LYNN PULLUM (DIRECTOR OF PATIENT ACCOUNTS)
(636) 669-2434
Entity
Organization
Contact information
Practice address
14021 NEW HALLS FERRY RD, FLORISSANT, MO 63033-2708
(314) 839-0910
(314) 839-9053
Mailing address
1551 WALL ST, SUITE 310, SAINT CHARLES, MO 63303-3541
(636) 669-2268
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
Other
Enumeration date
08/11/2006
Last updated
11/18/2010
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