Organization
SSM REGIONAL HEALTH SERVCIES
Active
Parent organization
SSM REGIONAL HEALTH SERVICES
Other names
St. Marys Urgent Care at the Lake
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM REGIONAL HEALTH SERVICES
Authorized official
BRENT VAN CONIA (PRESIDENT)
(573) 761-7000
Entity
Organization
Contact information
Practice address
2265 BAGNELL DAM BLVD, STE 103, LAKE OZARK, MO 65049-8603
(573) 365-6800
(573) 365-6011
Mailing address
PO BOX 1027, JEFFERSON CITY, MO 65102-1027
(573) 761-7246
(573) 761-6947
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507349108
—
MO
Enumeration date
05/25/2006
Last updated
10/28/2008
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