Provider Demographics
NPI:1669856829
Name:SSM REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SSM REGIONAL HEALTH SERVICES
Other - Org Name:SSM HEALTH MEDICAL GROUP - FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARRICK
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-280-7582
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1027
Mailing Address - Country:US
Mailing Address - Phone:573-681-3767
Mailing Address - Fax:
Practice Address - Street 1:2511 W EDGEWOOD DR STE F
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5869
Practice Address - Country:US
Practice Address - Phone:573-761-7979
Practice Address - Fax:573-761-0445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-16
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty