Organization
SSM MEDICAL GROUP INC.
Active
Parent organization
SSM MEDICAL GROUP INC.
Other names
SSM Health Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM MEDICAL GROUP INC.
Authorized official
BRIDGET EDER (PROVIDER ENROLLMENT SPECIALIST)
(636) 669-2268
Entity
Organization
Contact information
Practice address
1101 HIGHWAY K, O FALLON, MO 63366
(636) 379-6363
(636) 379-1297
Mailing address
1551 WALL ST, SUITE 310, SAINT CHARLES, MO 63303-3541
(636) 669-2268
(314) 209-8129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MO
207R00000X
Internal Medicine Physician
—
MO
207RR0500X
Rheumatology Physician
—
MO
207V00000X
Obstetrics & Gynecology Physician
—
MO
213E00000X
Podiatrist
—
MO
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501133607
—
MO
Enumeration date
09/22/2010
Last updated
07/16/2018
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