Provider Demographics
NPI:1962572396
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:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-768-8052
Mailing Address - Street 1:6420 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1811
Mailing Address - Country:US
Mailing Address - Phone:314-768-8000
Mailing Address - Fax:314-768-8011
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8000
Practice Address - Fax:314-768-8011
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:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO383-13282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE260091AMedicaid
IL43065268100Medicaid
FL903101400Medicaid
CAXHSP41677Medicaid
MO010326205Medicaid
KY01440882Medicaid
IN100380180AMedicaid
IL43065268140Medicaid
MO540326204Medicaid
CAXHSP31677Medicaid
MI302646861Medicaid
KS100414260AMedicaid
AZ101816Medicaid
MN672317900Medicaid
MS00220241Medicaid
NY02517408Medicaid
AR108497105Medicaid
MI408077020Medicaid
260091Medicare Oscar/Certification
IL=========40Medicaid