Provider Demographics
NPI:1396814083
Name:SSM HEALTH CARE ST. LOUIS
Entity Type:Organization
Organization Name:SSM HEALTH CARE ST. LOUIS
Other - Org Name:SSM HEALTH ST. JOSEPH HOSPITAL - ST. CHARLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-947-5076
Mailing Address - Street 1:300 1ST CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2844
Mailing Address - Country:US
Mailing Address - Phone:636-947-5000
Mailing Address - Fax:
Practice Address - Street 1:300 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2844
Practice Address - Country:US
Practice Address - Phone:636-947-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO494-0273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL430652671403Medicaid
IL430652671003Medicaid
MO540418100Medicaid
MO010418101Medicaid
MO540418100Medicaid