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Contact Information

SSM DEPAUL MEDICAL GROUP, INC.
2024 DORSETT VLG
MARYLAND HEIGHTS, MO63043-2208
 Phone: 314-590-0550
 Fax: 314-590-0560
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Neurological Surgery

207T00000X 02 Physician/General Surgery
 

Obstetrics & Gynecology

207V00000X 16 Physician/Obstetrics & Gynecology
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Rheumatology

207RR0500X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for SSM DEPAUL MEDICAL GROUP, INC.

NPI # 1760456743
LBN Legal business name SSM DEPAUL MEDICAL GROUP, INC.
Authorized official LAURA PULLUM - (BILLING MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/15/2006
Last updated 01/15/2016 - About 10 years ago
Identifiers
MO Medicaid 502915705
MO Other CJ7983 RAILROAD MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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