# SSM DEPAUL MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SSM DEPAUL MEDICAL GROUP
- **Other names:** DePaul Medical Group at Cross Keys
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1952312951
- **Legal business name:** SSM DEPAUL MEDICAL GROUP
- **Authorized official:** MS. LAURA LYNN PULLUM (DIRECTOR OF PATIENT ACCOUNTS)
- **Authorized official phone:** (636) 669-2434

## Contact information

- **Practice address:** 14021 NEW HALLS FERRY RD, FLORISSANT, MO 63033-2708
- **Practice address phone:** (314) 839-0910
- **Practice address fax:** (314) 839-9053
- **Mailing address:** 1551 WALL ST, SUITE 310, SAINT CHARLES, MO 63303-3541
- **Mailing address phone:** (636) 669-2268

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 11/18/2010