Organization
SSM ST. JOSEPH HEALTH CENTER
Active
Other names
The Imaging Center at St. Joseph Medical Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN JOHNSON (PRESIDENT)
(314) 989-2072
Entity
Organization
Contact information
Practice address
1475 KISKER RD, SAINT CHARLES, MO 63304-8781
(636) 498-7400
(636) 498-7420
Mailing address
1836 LACKLAND HILL PKWY, ATTNT: CREDENTIALING DEPARTMENT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
(636) 498-7420
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00137824
RR MEDICARE
MO
01
—
P00243976
RR MEDICARE
MO
Enumeration date
06/12/2006
Last updated
12/22/2008
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