Provider Demographics
NPI:1598835308
Name:SSM HEALTH CARE ST. LOUIS
Entity type:Organization
Organization Name:SSM HEALTH CARE ST. LOUIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-344-7210
Mailing Address - Street 1:12303 DE PAUL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2512
Mailing Address - Country:US
Mailing Address - Phone:314-344-6000
Mailing Address - Fax:
Practice Address - Street 1:12303 DE PAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2512
Practice Address - Country:US
Practice Address - Phone:314-344-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO414-11282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100411820AMedicaid
AR149006105Medicaid
LA1702471Medicaid
FL911294400Medicaid
KY01400001Medicaid
MO540494101Medicaid
CO72101326Medicaid
CAXHSP33320Medicaid
MO010494102Medicaid
IA0553719Medicaid
IN200360100AMedicaid
IL431704972401Medicaid
MN756053200Medicaid
AZ833203Medicaid
CAXHSP43320Medicaid
MS07184768Medicaid
NE43170497200Medicaid
IL431704972001Medicaid
MN756053200Medicaid
260104Medicare Oscar/Certification