Organization
SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
Active
Parent organization
SSM HEALTH CARE CORPORATION
Other names
SSM Health Cardinal Glennon Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM HEALTH CARE CORPORATION
Authorized official
TIM BULLER (REGIONAL CFO - FINANCIAL STRATEGY)
(314) 989-2173
Entity
Organization
Contact information
Practice address
132 PROFESSIONAL PKWY, TROY, MO 63379-2823
(636) 462-5437
Mailing address
1195 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-1716
(314) 989-3524
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
505459107
—
MO
Enumeration date
11/13/2006
Last updated
07/19/2019
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