| Ssm Health Medical Group - Pediatrics | |
|
3348 American Ave Jefferson City MO 65109-1079 | |
| (573) 761-7210 | |
| (573) 634-8802 |
| Full Name | Ssm Health Medical Group - Pediatrics |
|---|---|
| Speciality | Clinic/Center |
| Location | 3348 American Ave, Jefferson City, Missouri |
| Authorized Official Name and Position | Garrick Elliott Mueller (CFO) |
| Authorized Official Contact | 4052807582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssm Health Medical Group - Pediatrics Po Box 1027 Jefferson City MO 65102-1027 Ph: (573) 681-3767 | Ssm Health Medical Group - Pediatrics 3348 American Ave Jefferson City MO 65109-1079 Ph: (573) 761-7210 |
| NPI Number | 1396782587 |
|---|---|
| Provider Enumeration Date | 05/31/2006 |
| Last Update Date | 09/15/2020 |
| Medicare PECOS PAC ID | 8921917352 |
|---|---|
| Medicare Enrollment ID | O20040907000920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396782587 | NPI | - | NPPES |
| 501283501 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jennifer P Krause |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1255361036 PECOS PAC ID: 5799756334 Enrollment ID: I20040805000539 |
| Provider Name | Brian Conley |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093746653 PECOS PAC ID: 8820031404 Enrollment ID: I20050606000022 |
| Provider Name | Bridgett A Wekenborg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912258195 PECOS PAC ID: 0345495479 Enrollment ID: I20130221000254 |
| Provider Name | Olga Brea Pena |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1417333253 PECOS PAC ID: 3173875226 Enrollment ID: I20181017003486 |
| Provider Name | Megan Marie Kruse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477274827 PECOS PAC ID: 5890166219 Enrollment ID: I20230123002741 |
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