Provider Demographics
NPI:1336350214
Name:SSM AUDRAIN HEALTH CARE, INC.
Entity Type:Organization
Organization Name:SSM AUDRAIN HEALTH CARE, INC.
Other - Org Name:SSM HEALTH MEDICAL GROUP- PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-681-3129
Mailing Address - Street 1:1001 SOUTHWEST BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2501
Mailing Address - Country:US
Mailing Address - Phone:573-681-3000
Mailing Address - Fax:573-761-6947
Practice Address - Street 1:3626 S CLARK ST
Practice Address - Street 2:SUITE A
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-4104
Practice Address - Country:US
Practice Address - Phone:573-581-7366
Practice Address - Fax:573-581-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011724Medicare PIN
MO000011832Medicare PIN
MO000050005Medicare PIN
MO000011725Medicare PIN
MO000015010Medicare PIN
MO000011808Medicare PIN
MO000092343Medicare PIN
MO000095141Medicare PIN
MO000015375Medicare PIN
MO000012108Medicare PIN