Provider Demographics
NPI:1952390122
Name:SSM AUDRAIN HEALTH CARE, INC
Entity Type:Organization
Organization Name:SSM AUDRAIN HEALTH CARE, INC
Other - Org Name:SSM HEALTH ST. MARY'S HOSPITAL-AUDRAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-582-5000
Mailing Address - Street 1:620 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2919
Mailing Address - Country:US
Mailing Address - Phone:573-582-5000
Mailing Address - Fax:573-582-3723
Practice Address - Street 1:620 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2919
Practice Address - Country:US
Practice Address - Phone:573-582-5000
Practice Address - Fax:573-582-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36-50282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO260064Medicare Oscar/Certification
MO260064Medicare PIN