Provider Demographics
NPI:1134400484
Name:SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Entity type:Organization
Organization Name:SSM CARDIOVASCULAR AND THORACIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:RENKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2160
Mailing Address - Street 1:12855 N 40 DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-880-6100
Mailing Address - Fax:314-997-6033
Practice Address - Street 1:1027 BELLEVUE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1851
Practice Address - Country:US
Practice Address - Phone:314-645-6450
Practice Address - Fax:314-645-2560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FPP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty