Provider Demographics
NPI:1518065523
Name:SSM REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SSM REGIONAL HEALTH SERVICES
Other - Org Name:SSM HEALTH ST. MARY'S HOSPITAL JEFFERSON CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-994-6219
Mailing Address - Street 1:2505 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-9508
Mailing Address - Country:US
Mailing Address - Phone:573-681-3000
Mailing Address - Fax:573-681-3621
Practice Address - Street 1:2505 MISSION DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-9508
Practice Address - Country:US
Practice Address - Phone:573-681-3000
Practice Address - Fax:573-681-3621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
MO455-14282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010322600Medicaid
MOPCCH2014OtherRR MEDICARE
MO000014546Medicare PIN
MOPCCH2014OtherRR MEDICARE
MO000050114Medicare PIN
MO260011Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MO268613Medicare ID - Type UnspecifiedELDON MEDICAL CLINIC