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SSM Depaul Medical Group, Inc.

Organization Active NPI Neurological Surgery Physician · Bridgeton, MO

NPI 1154434736 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1154434736
Entity type
Organization (NPI type 2)
Primary specialty
Neurological Surgery Physician 207T00000X
Legal business name
SSM DEPAUL MEDICAL GROUP, INC.
Practice address
12255 De Paul Dr
Suite 830
Bridgeton, MO 63044-2510
Phone
(314) 291-6556
NPI assigned
Aug 16, 2006
Organization subpart
No

Authorized official

Name
Ms. Laura Pullum
Title
Director of Patient Accounts
Phone
(314) 209-8121

Corporate family (same tax ID) 12

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
SSM Depaul Medical Group Inc (13 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207T00000X Yes

Addresses

Primary practice location

12255 De Paul Dr
Suite 830
Bridgeton, MO 63044-2510

Mailing address

12255 De Paul Dr
Suite 830
Bridgeton, MO 63044-2510
Phone (314) 291-6556

Other names

  • DePaul Medical Group Neurosurgery Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154434736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "address_2": "SUITE 830",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-291-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR",
            "address_2": "SUITE 830",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442510",
            "telephone_number": "314-291-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM DEPAUL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PULLUM",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "314-209-8121",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DePaul Medical Group Neurosurgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, MO

All providers in Bridgeton, MO · Neurological Surgery Physician in Missouri

Sources for this page

Verify at the official NPI Registry.