Provider Demographics
NPI:1851312714
Name:SSM MEDICAL GROUP
Entity Type:Organization
Organization Name:SSM MEDICAL GROUP
Other - Org Name:ST. LOUIS MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-238-9100
Mailing Address - Street 1:7980 CLAYTON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1354
Mailing Address - Country:US
Mailing Address - Phone:314-951-5368
Mailing Address - Fax:314-951-5238
Practice Address - Street 1:3555 SUNSET OFFICE DR
Practice Address - Street 2:SUITE C-100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1015
Practice Address - Country:US
Practice Address - Phone:314-238-9100
Practice Address - Fax:314-238-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501906101Medicaid
MO501906101Medicaid