Provider Demographics
NPI:1346237112
Name:SSM HEALTH CARE ST. LOUIS
Entity Type:Organization
Organization Name:SSM HEALTH CARE ST. LOUIS
Other - Org Name:SSM HEALTH DEPAUL HOSPITAL - ANNA HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-344-7210
Mailing Address - Street 1:12303 DEPAUL DR.
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2512
Mailing Address - Country:US
Mailing Address - Phone:314-209-8814
Mailing Address - Fax:314-209-8823
Practice Address - Street 1:12303 DEPAUL DR.
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2512
Practice Address - Country:US
Practice Address - Phone:314-209-8814
Practice Address - Fax:314-209-8823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-05
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO41410314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101498608Medicaid