Provider Demographics
NPI:1467521146
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
MO494-0282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL911244800Medicaid
MS04782395Medicaid
NE43065267100Medicaid
AZ797508Medicaid
WV9810174000Medicaid
IL430652671003Medicaid
OH0072433Medicaid
MO010418101Medicaid
MO540418100Medicaid
CAXHSP33509Medicaid
CAXHSP43509Medicaid
KY01400399Medicaid
AR155128105Medicaid
IL430652671403Medicaid
LA1703192Medicaid
KS100398550AMedicaid
OK200023220AMedicaid
GA287522852AMedicaid
FL911244800Medicaid
260005Medicare Oscar/Certification