Organization
SSM HEALTH CARE ST. LOUIS
Active
Other names
SSM Health St. Joseph Hospital - Wentzville Physician Billing
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN JOHNSON (PRESIDENT)
(314) 989-2072
Entity
Organization
Contact information
Practice address
500 MEDICAL DR, WENTZVILLE, MO 63385-3421
(636) 327-1117
Mailing address
1836 LACKLAND HILL PKWY, ATTNT: CREDENTIALING DEPARTMENT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
540418100
—
MO
Enumeration date
05/20/2006
Last updated
12/04/2015
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