Provider Demographics
NPI:1871665380
Name:SSM HEALTH CARE ST. LOUIS
Entity Type:Organization
Organization Name:SSM HEALTH CARE ST. LOUIS
Other - Org Name:SSM HEALTH ST JOSEPH HOSPITAL - LAKE SAINT LOUIS
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:636-625-5330
Mailing Address - Street 1:100 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1366
Mailing Address - Country:US
Mailing Address - Phone:636-625-5200
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1366
Practice Address - Country:US
Practice Address - Phone:636-625-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
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
MD406080600Medicaid
TN0260200Medicaid
IL431417442001Medicaid
NE10025224700Medicaid
LA1704971Medicaid
IL431417442401Medicaid
KS100448550AMedicaid
NM13450379Medicaid
IN200417580AMedicaid
GA519219208AMedicaid
MO542361605Medicaid
MO012361606Medicaid
CAXHSP43652Medicaid
PA001452362Medicaid
IA0551366Medicaid
AR149377105Medicaid
OH2339893Medicaid
CAXHSP33652Medicaid
AR149377105Medicaid
260200Medicare Oscar/Certification