Provider Demographics
NPI:1114190725
Name:SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Entity Type:Organization
Organization Name:SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Other - Org Name:SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RENKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2160
Mailing Address - Street 1:400 1ST CAPITOL DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2880
Mailing Address - Country:US
Mailing Address - Phone:314-647-8269
Mailing Address - Fax:314-646-1700
Practice Address - Street 1:400 1ST CAPITOL DR
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2880
Practice Address - Country:US
Practice Address - Phone:314-647-8269
Practice Address - Fax:314-646-1700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty