Organization
SSM DEPAUL MEDICAL GROUP, INC.
Active
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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