Provider Demographics
NPI:1912194465
Name:SLSSC, LLC
Entity Type:Organization
Organization Name:SLSSC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-561-8900
Mailing Address - Street 1:633 EMERSON RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6739
Mailing Address - Country:US
Mailing Address - Phone:618-535-0851
Mailing Address - Fax:
Practice Address - Street 1:633 EMERSON RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:618-535-0851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center