| Ssm Health Wound Center | |
|
2505 Mission Dr Suite 210 Jefferson City MO 65109-9508 | |
| (573) 681-3000 | |
| (573) 659-2503 |
| Full Name | Ssm Health Wound Center |
|---|---|
| Speciality | General Practice |
| Location | 2505 Mission Dr, 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 Wound Center Po Box 1027 Jefferson City MO 65102-1027 Ph: (573) 681-3767 | Ssm Health Wound Center 2505 Mission Dr Suite 210 Jefferson City MO 65109-9508 Ph: (573) 681-3000 |
| NPI Number | 1043450711 |
|---|---|
| Provider Enumeration Date | 02/20/2009 |
| Last Update Date | 09/15/2020 |
| Medicare PECOS PAC ID | 8921917352 |
|---|---|
| Medicare Enrollment ID | O20050510000839 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043450711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Matthew M Fiori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164519963 PECOS PAC ID: 3476505538 Enrollment ID: I20050420000311 |
| Provider Name | Gary Baskett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922039817 PECOS PAC ID: 0345277141 Enrollment ID: I20050725000001 |
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