| Ssm Medical Group Dba Joseph C. Rudolph, M.d. | |
|
1747 Smizer Station Rd Suite 6 Fenton MO 63026-2784 | |
| (636) 225-7908 | |
| (636) 225-7497 |
| Full Name | Ssm Medical Group Dba Joseph C. Rudolph, M.d. |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1747 Smizer Station Rd, Fenton, Missouri |
| Authorized Official Name and Position | Deborah B. Reichardt (OFFICE MANAGER) |
| Authorized Official Contact | 6362257908 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssm Medical Group Dba Joseph C. Rudolph, M.d. 1747 Smizer Station Rd Suite 6 Fenton MO 63026-2784 Ph: (636) 225-7908 | Ssm Medical Group Dba Joseph C. Rudolph, M.d. 1747 Smizer Station Rd Suite 6 Fenton MO 63026-2784 Ph: (636) 225-7908 |
| NPI Number | 1770789984 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770789984 | NPI | - | NPPES |
| 1376561464 | Other | MO | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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