Organization
SSMDEPAUL MEDICAL GROUP
Active
Parent organization
SSM DEPAUL MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM DEPAUL MEDICAL GROUP
Authorized official
BRIDGET FRANCIS (CREDENTILAING COORDINATOR)
(636) 669-2268
Entity
Organization
Contact information
Practice address
1551 WALL ST, SUITE 400, SAINT CHARLES, MO 63303-3539
(636) 669-2350
(636) 669-2221
Mailing address
1551 WALL ST, SUITE 310, SAINT CHARLES, MO 63303-3539
(636) 669-2268
(314) 209-8127
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MO
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502915705
—
MO
Enumeration date
10/04/2010
Last updated
10/04/2010
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