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SSM DEPAUL MEDICAL GROUP INC. NPI 1952312951


NPI Information

NPI: 1952312951
Provider Name: SSM DEPAUL MEDICAL GROUP, INC.

Doing Business As: DEPAUL MEDICAL GROUP AT CROSS KEYS

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 26D0870082

Address:
14021 NEW HALLS FERRY RD
FLORISSANT, MO
ZIP 63033
Phone: (314) 839-0910
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SSM DEPAUL MEDICAL GROUP, INC. is a family medicine in Florissant, MO. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SSM DEPAUL MEDICAL GROUP, INC. NPI is 1952312951. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Depaul Medical Group At Cross Keys.

The provider's business location address is:

14021 NEW HALLS FERRY RD
FLORISSANT, MO
ZIP 63033-708
Phone: (314) 839-0910
Fax: (314) 839-9053

The provider's authorized official is Laura Lynn Pullum .
The authorized official title is Director Of Patient Accounts and has the following contact phone number (636) 669-2434.

The CLIA number assigned to this NPI record is 26D0870082 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/11/2006 and was last updated on 11/18/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsNo
2213E00000XPodiatristNo
3207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16438130003OTHERMISSOURIMEDICARE DME
26438130003MEDICARE NSCMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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