Organization
SSM MEDICAL GROUP
Active
Other names
SSM Medical Group DBA Joseph C. Rudolph, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH B. REICHARDT (OFFICE MANAGER)
(636) 225-7908
Entity
Organization
Contact information
Practice address
1747 SMIZER STATION RD, SUITE 6, FENTON, MO 63026-2784
(636) 225-7908
(636) 225-7497
Mailing address
1747 SMIZER STATION RD, SUITE 6, FENTON, MO 63026-2784
(636) 225-7908
(636) 225-7497
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376561464
INDIVIDUAL NPI
MO
Enumeration date
06/25/2007
Last updated
08/22/2020
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