Provider Demographics
NPI:1255470050
Name:PHYSICIANS OF SSM ST LOUIS
Entity Type:Organization
Organization Name:PHYSICIANS OF SSM ST LOUIS
Other - Org Name:DALIUS KEDAINIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRES OF PATIENT FINANCIAL SERV
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2180
Mailing Address - Street 1:300 MEDICAL PLZ
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1481
Mailing Address - Country:US
Mailing Address - Phone:636-625-1111
Mailing Address - Fax:636-625-8566
Practice Address - Street 1:300 MEDICAL PLZ
Practice Address - Street 2:SUITE 230
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1481
Practice Address - Country:US
Practice Address - Phone:636-625-1111
Practice Address - Fax:636-625-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006016942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty