SSM ST. CHARLES CLINIC MEDICAL GROUP, INC. (NPI# 1578670949) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578670949 |
| Entity Type | Organization |
| Organization Name | SSM ST. CHARLES CLINIC MEDICAL GROUP, INC. |
| Other Organization Name | SSM HEALTH MEDICAL GROUP |
| Practice Address |
722 N Highway 47 Suite B Warrenton MO 63383-1108 |
| Mailing Address |
1551 Wall St Suite 310 Saint Charles MO 63303-3539 |
| Practice Telephone | 6364563413 |
| Practice Fax Number | 6366692401 |
| Mailing Telephone | 6366692268 |
| Mailing Fax Number | 3142098127 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2016-01-15 |
| Authorized Official Name | MS. LAURA PULLUM (BILLING MANAGER) |
| Authorized Official Telephone | 6366692434 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 501133649 | 05 |
| Other Name | Type Code |
|---|---|
| SSM Health Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528421260 | Ssm St. Charles Clinic Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 1475 Kisker Rd, Suite 200, Saint Charles, MO 63304-8781 | 2016-03-31 |
| 1285741629 | Ssm St. Charles Clinic Medical Group, Inc. | Family Medicine | 172 Professional Parkway, Troy, MO 63379-1520 | 2006-08-23 |
| 1811932973 | Ssm St. Charles Clinic Medical Group, Inc. | Internal Medicine | 1551 Wall St, Suite 400, Saint Charles, MO 63303-3539 | 2006-06-20 |
| Street Address |
722 N HIGHWAY 47 SUITE B |
| City | WARRENTON |
| State | MO |
| Zip Code | 63383-1108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073519773 | Janelle S Carron | Nurse Practitioner | 722 N Highway 47, Ste B, Warrenton, MO 63383-1108 | 2005-06-27 |
| 1255639019 | Judith L Hustermann | Nurse Practitioner | 722 N Highway 47, Warrenton, MO 63383-1108 | 2011-03-03 |
| 1124356845 | Mary Walsh-scott | Physical Therapist | 722 N Highway 47, Warrenton, MO 63383-1108 | 2009-11-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215544861 | Amanda Rae Miller | Pharmacist | 701 North Highway 47, Warrenton, MO 63383 | 2020-09-28 |
| 1255837647 | Amanda Jean Hite | Physical Therapy Assistant | 1 Town and Country Marketplace, Warrenton, MO 63383 | 2018-04-04 |
| 1295260818 | Legacy Drugstore 2, LLC | Pharmacy | 609 State Highway 47, Suite B, Warrenton, MO 63383 | 2017-04-21 |
| 1295281517 | Harbor Place Estates, LLC | Assisted Living Facility | 1054 S State Highway 47, Warrenton, MO 63383 | 2016-08-28 |
| 1811350630 | Megan Moore | Physical Therapist | 772 N. Hwy 47, Suite A, Warrenton, MO 63383 | 2016-03-30 |
| 1598125353 | Lauren Schumacher | Physical Therapist | 722 N. Highway 47, Suite A, Warrenton, MO 63383 | 2016-03-07 |
| 1427374230 | Our Urgent Care, LLC | Clinic/Center | 1343 North East Service Rd, Warrenton, MO 63383 | 2010-04-19 |
| 1235397183 | Paul J Dooley Dds PC | Dentist | 708 Steinhagen, Warrenton, MO 63383 | 2008-05-28 |
| 1699975995 | Joshua Douglas Sharp | Chiropractor | 704 North State Hwy 47, Warrenton, MO 63383 | 2007-07-24 |
| 1083827075 | Thomas William Cox | Physical Therapy Assistant | 65 State Hwy. Aa, Warrenton, MO 63383 | 2007-05-07 |
| Find all providers in zip 63383 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275913790 | Todd Horstman | Family Medicine | 722 N State Highway 47 Ste B, Warrenton, MO 63383-1108 | 2015-06-01 |
| 1831577196 | Elizabeth Dietrich Erikson | Family Medicine | 1639 Se Ensign Ln Ste B103, Warrenton, OR 97146 | 2015-05-07 |
| 1164815262 | Carolina Medicorp Enterprises Inc | Family Medicine | 480 Fletcher Dr, Suite 3, Warrenton, VA 20186-2185 | 2015-03-13 |
| 1144665407 | Ahmad Babar | Family Medicine | 225 Oak Springs Dr Ste 101, Warrenton, VA 20186-2186 | 2013-04-30 |
| 1295048031 | Charles Patrick Coyne IIi | Family Medicine | 521 Anwijo Way, Warrenton, MO 63383-1388 | 2010-07-22 |
| 1225135965 | Liza A Cua | Family Medicine | 91400 N. Neacoxie Street, Bldg 7315, Warrenton, OR 97146 | 2006-09-17 |
| 1972606820 | Beckford Avenue Medical Center Inc | Family Medicine | 816 Us Hwy 158 W Suite 102, Warrenton, NC 27589 | 2006-09-06 |
| 1134142391 | Lillian Rae Horne | Family Medicine | 816 Us Hwy 158 Business West, Warrenton, NC 27589 | 2006-07-26 |
| 1346272739 | Alexander Gloria | Family Medicine | 171 S Highway 101, Warrenton, OR 97146 | 2006-07-07 |
| 1710915707 | Toni Kilyk | Family Medicine | 210 W Shirley Ave, Warrenton, VA 20186-3009 | 2006-06-29 |
| Find all providers in WARRENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.