Provider Demographics
NPI:1528014156
Name:SSM REGIONAL HEALTH SERVICES
Entity type:Organization
Organization Name:SSM REGIONAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN CONIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-761-7000
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1027
Mailing Address - Country:US
Mailing Address - Phone:573-761-7246
Mailing Address - Fax:573-761-6947
Practice Address - Street 1:1112 E NORTH ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-2602
Practice Address - Country:US
Practice Address - Phone:573-392-3767
Practice Address - Fax:573-392-1976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center