Organization
SSM DEPAUL MEDICAL GROUP, INC.
Active
Other names
SSM Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA L PULLUM (BILLING MANAGER)
(636) 669-2434
Entity
Organization
Contact information
Practice address
2024 DORSETT VLG, MARYLAND HEIGHTS, MO 63043-2208
(314) 590-0550
(314) 590-0560
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
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502915705
—
MO
01
—
CJ7983
RAILROAD MEDICARE
MO
Enumeration date
02/15/2006
Last updated
01/15/2016
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