Organization
SSM ST. CHARLES CLINIC MEDICAL GROUP, INC.
Active
Other names
SSM Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA PULLUM (BILLING MANAGER)
(636) 669-2434
Entity
Organization
Contact information
Practice address
1551 WALL ST, SUITE 400, SAINT CHARLES, MO 63303-3539
(636) 669-2350
(636) 669-2221
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
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501133607
—
MO
Enumeration date
06/20/2006
Last updated
01/15/2016
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