SSM Regional Health Servcies

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

SSM REGIONAL HEALTH SERVCIES

Practice address

2265 Bagnell Dam Blvd
Ste 103
Lake Ozark, MO 65049-8603

Phone

(573) 365-6800

Fax

(573) 365-6011

NPI assigned

May 25, 2006

Organization subpart

Yes

Parent organization

SSM REGIONAL HEALTH SERVICESAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brent Van Conia

Title

President

Phone

(573) 761-7000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Marys Urgent Care at the Lake Doing business as

Part of

St Marys Holts Summit Phar

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• SSM Regional Health Services

  • Oncology Clinic/Center
  • Jefferson City, MO
  • NPI 1619923240

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1316993256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651021027",
            "telephone_number": "573-761-7246",
            "fax_number": "573-761-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2265 BAGNELL DAM BLVD",
            "address_2": "STE 103",
            "city": "LAKE OZARK",
            "state": "MO",
            "postal_code": "650498603",
            "telephone_number": "573-365-6800",
            "fax_number": "573-365-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM REGIONAL HEALTH SERVCIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM REGIONAL HEALTH SERVICES",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "VAN CONIA",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-761-7000"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507349108",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Marys Urgent Care at the Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacy Leigh Sederwall, FNP
• Serc Rehabilitation Partners LLC
• Justin William Shaw, BCN
• Sheila Sims, MS, L.AC., LMT
• Brynn Smith
• Heidi Stanfield, P.L.P.C.
• Stephen Paul Stewart, MD
• Evonna Surrette
• Eric Swisher, MS, CIT
• The Lime in the Coconut Specialty Compounding Pharmacy, LLC

• All providers in Lake Ozark, MO
• Urgent Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.