Provider Demographics
NPI:1871536037
Name:SSM ST. JOSEPH ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:SSM ST. JOSEPH ENDOSCOPY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM VICE PRESIDENT FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:REWERTS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:314-989-6843
Mailing Address - Street 1:10176 CORPORATE SQUARE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2924
Mailing Address - Country:US
Mailing Address - Phone:314-989-6843
Mailing Address - Fax:314-344-7281
Practice Address - Street 1:4203 S CLOVER LEAF
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63376-6452
Practice Address - Country:US
Practice Address - Phone:636-498-7400
Practice Address - Fax:314-344-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000040066Medicare PIN