| Ssmdepaul Medical Group | |
|
1551 Wall St Suite 400 Saint Charles MO 63303-3539 | |
| (636) 669-2350 | |
| (636) 669-2221 |
| Full Name | Ssmdepaul Medical Group |
|---|---|
| Speciality | Podiatrist - Foot & Ankle Surgery |
| Location | 1551 Wall St, Saint Charles, Missouri |
| Authorized Official Name and Position | Bridget Francis (CREDENTILAING COORDINATOR) |
| Authorized Official Contact | 6366692268 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssmdepaul Medical Group 1551 Wall St Suite 310 Saint Charles MO 63303-3539 Ph: (636) 669-2268 | Ssmdepaul Medical Group 1551 Wall St Suite 400 Saint Charles MO 63303-3539 Ph: (636) 669-2350 |
| NPI Number | 1457660896 |
|---|---|
| Provider Enumeration Date | 10/04/2010 |
| Last Update Date | 10/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457660896 | NPI | - | NPPES |
| 502915705 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Missouri) | Secondary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | (Missouri) | Primary |
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