Provider Demographics
NPI:1316953656
Name:SSM MEDICAL GROUP
Entity type:Organization
Organization Name:SSM MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DRIECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHNARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-822-5900
Mailing Address - Street 1:10777 SUNSET OFFICE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1019
Mailing Address - Country:US
Mailing Address - Phone:314-822-5900
Mailing Address - Fax:314-822-5919
Practice Address - Street 1:3555 SUNSET OFFICE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1015
Practice Address - Country:US
Practice Address - Phone:314-822-5900
Practice Address - Fax:314-822-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013910Medicare ID - Type UnspecifiedMEDIARE NUMBER