| Ssm Health Depaul Hospital - St. Louis | |
|
12303 De Paul Dr Bridgeton MO 63044-2512 | |
| (314) 344-6000 | |
| Not Available |
| Full Name | Ssm Health Depaul Hospital - St. Louis |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 12303 De Paul Dr, Bridgeton, Missouri |
| Authorized Official Name and Position | Tina Garrison (PRESIDENT) |
| Authorized Official Contact | 3143447210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssm Health Depaul Hospital - St. Louis 12303 De Paul Dr Bridgeton MO 63044-2512 Ph: (314) 344-6000 | Ssm Health Depaul Hospital - St. Louis 12303 De Paul Dr Bridgeton MO 63044-2512 Ph: (314) 344-6000 |
| NPI Number | 1053481861 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 08/31/2021 |
| Certification Date | 08/31/2021 |
| Medicare PECOS PAC ID | 7810800737 |
|---|---|
| Medicare Enrollment ID | O20160223001141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053481861 | NPI | - | NPPES |
| 431704972001 | Medicaid | IL | |
| 431704972401 | Medicaid | IL | |
| 540494101 | Medicaid | MO | |
| 010494102 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 414-11 (Missouri) | Primary |
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