Provider Demographics
NPI:1679510861
Name:SSM REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SSM REGIONAL HEALTH SERVICES
Other - Org Name:CENTER FOR PLASTICS & RESTORATIVE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN CONIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-761-7000
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:573-632-4325
Mailing Address - Fax:573-761-2006
Practice Address - Street 1:200 SAINT MARYS PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1604
Practice Address - Country:US
Practice Address - Phone:573-632-4325
Practice Address - Fax:573-659-2503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center