Provider Demographics
NPI:1902281181
Name:SSM-SLUH INC
Entity Type:Organization
Organization Name:SSM-SLUH INC
Other - Org Name:SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO - FINANCIAL STRATEGY
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2173
Mailing Address - Street 1:1195 CORPORATE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1716
Mailing Address - Country:US
Mailing Address - Phone:314-989-3524
Mailing Address - Fax:314-989-3695
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-577-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
262310Medicare Oscar/Certification