Provider Demographics
NPI:1285639039
Name:SSM DIVERSIFIED CORPORATION
Entity Type:Organization
Organization Name:SSM DIVERSIFIED CORPORATION
Other - Org Name:SSM HOME MEDICAL EQUIPMENT COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOENHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-994-7900
Mailing Address - Street 1:10143 PAGET DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2915
Mailing Address - Country:US
Mailing Address - Phone:888-705-6060
Mailing Address - Fax:314-989-2556
Practice Address - Street 1:10143 PAGET DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2915
Practice Address - Country:US
Practice Address - Phone:888-705-6060
Practice Address - Fax:314-989-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12198510332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0408050001Medicare NSC