Provider Demographics
NPI:1285004598
Name:SSM MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SSM MEDICAL GROUP INC.
Other - Org Name:SSM HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:EDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-498-5944
Mailing Address - Street 1:3221 MCKELVEY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2551
Mailing Address - Country:US
Mailing Address - Phone:636-498-5944
Mailing Address - Fax:314-209-8127
Practice Address - Street 1:12255 DEPAUL DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-291-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty