Organization
SSM ST CHARLES CLINIC MEDICAL GROUP
Active
Organization
SSM ST CHARLES CLINIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA PULLUM (DIRECTOR)
(636) 669-2434
Entity
Organization
Contact information
Practice address
400 MEDICAL PLZ, SUITE 200, LAKE ST LOUIS, MO 63367-1490
(636) 625-2662
(636) 625-1121
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
363LF0000X
Family Nurse Practitioner
Primary
2013015582
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008020336
LICENSE
MO
Enumeration date
11/08/2013
Last updated
11/08/2013
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up