SSM AUDRAIN HEALTH CARE, INC. (NPI# 1336576008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336576008 |
| Entity Type | Organization |
| Organization Name | SSM AUDRAIN HEALTH CARE, INC. |
| Other Organization Name | SSM HEALTH MEDICAL GROUP - WOMEN'S HEALTH |
| Practice Address |
605 E Promenade St Suite A Mexico MO 65265-2926 |
| Mailing Address |
626 E Summit St Suite K Mexico MO 65265-3298 |
| Practice Telephone | 5735824104 |
| Mailing Telephone | 5735818127 |
| Mailing Fax Number | 5735827053 |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2015-05-08 |
| Authorized Official Name | ROBERT B. VANCONIA (CEO) |
| Authorized Official Telephone | 5735818100 |
| Is Organization Subpart | Y |
| Parent Organization Name | SSM AUDRAIN HEALTH CARE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 2011003920 | MO | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| SSM Health Medical Group - Women's Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801225982 | Ssm Audrain Health Care, Inc. | Clinic/Center | 201 S. Main, Auxvasse, MO 65231 | 2013-11-08 |
| 1255340246 | Ssm Audrain Health Care, Inc. | Family Medicine | 1223 Main Street, Perry, MO 63462 | 2006-08-07 |
| 1356712871 | Ssm Audrain Health Care, Inc. | Psychiatric Unit | 620 E Monroe St, Mexico, MO 65265-2919 | 2015-10-09 |
| 1548520026 | Ssm Audrain Health Care, Inc. | Family Medicine | 221 N Main St, Paris, MO 65275-1328 | 2012-05-18 |
| 1336350214 | Ssm Audrain Health Care, Inc. | Family Medicine | 3626 S Clark St, Suite A, Mexico, MO 65265-4104 | 2007-05-24 |
| 1790838316 | Ssm Audrain Health Care, Inc. | Family Medicine | 3626 S Clark St, Mexico, MO 65265-4104 | 2007-01-18 |
| 1457469637 | Ssm Audrain Health Care, Inc. | Pediatrics | 3626 S Clark St Ste A, Mexico, MO 65265-4104 | 2006-08-28 |
| 1477563625 | Ssm Audrain Health Care, Inc. | Family Medicine | 625 E Summit St, Mexico, MO 65265-3294 | 2006-08-09 |
| 1871503466 | Ssm Audrain Health Care, Inc. | Internal Medicine | 600 Medical Park Dr, Mexico, MO 65265-3724 | 2006-08-08 |
| 1467462010 | Ssm Audrain Health Care, Inc. | Family Medicine | 626 E Summit St Ste L, Mexico, MO 65265-3298 | 2006-08-08 |
| Street Address |
605 E PROMENADE ST SUITE A |
| City | MEXICO |
| State | MO |
| Zip Code | 65265-2926 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639150352 | Janice Lynn Brockus | Speech-Language Pathologist | 605 E Promenade St, Mexico, MO 65265-2926 | 2005-11-09 |
| 1013324854 | Ssm Health Businesses | Hospice Care, Community Based | 605 E Promenade St, Mexico, MO 65265-2926 | 2014-07-14 |
| 1568878411 | Ssm Health Businesses | Home Health | 605 E Promenade St, Mexico, MO 65265-2926 | 2014-07-10 |
| 1023099439 | Audrain County Health Center | Public Health or Welfare | 605 E Promenade St, Mexico, MO 65265-0957 | 2005-11-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700448685 | Joanna Zidick Mcclarey | Specialist/Technologist | Rehabilitation Services, 711 E Jackson, Mexico, MO 65265 | 2019-07-01 |
| 1053858050 | Glenna Wilson | Social Worker | 2462 Southern Hls, Mexico, MO 65265 | 2017-01-27 |
| 1457601759 | Bruce Warren Garrett | Dentist | 626 Summit, Mexico, MO 65265 | 2012-09-13 |
| 1063775997 | Brandon Jay Glasgow | Physical Therapist | 2759 A S Clark, Mexico, MO 65265 | 2012-06-15 |
| 1407044548 | Missouri Central Physical Therapy, LLC | Specialist | 2759 A South Clark, Mexico, MO 65265 | 2007-10-12 |
| 1194925628 | Curators of The University of Missouri | Orthopaedic Surgery | 515 East Promenade, Mexico, MO 65265 | 2007-07-23 |
| 1740496199 | Scott Simmons | Family Medicine | 1000 Webster Street, Mexico, MO 65265 | 2007-05-15 |
| 1083741664 | Finck & Associates, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17079 Audrain County Road 929, Mexico, MO 65265 | 2007-02-28 |
| 1417005893 | Matthew Eugene Hart | Emergency Medicine | 620 E Monroe Street, Mexico, MO 65265 | 2007-01-08 |
| 1144392051 | Corrine M Floyd | Massage Therapist | 713 East Jackson, Mexico, MO 65265 | 2006-11-15 |
| Find all providers in zip 65265 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972523991 | Michael D Jones | Obstetrics & Gynecology | 626 E Summit St Ste J, Mexico, MO 65265-3298 | 2006-07-20 |
| 1689843708 | Mexico Womens Health Specialists | Obstetrics & Gynecology | 626 E Summit St Ste J, Mexico, MO 65265-3298 | 2008-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403334 | Sarah Mai Truong | Obstetrics & Gynecology | 402 N Keene St # Dc570.00, Columbia, MO 65201-6986 | 2020-06-30 |
| 1962049593 | Michael Wayne Mccullough | Obstetrics & Gynecology | 500 N Keene St Ste 400, Columbia, MO 65201-8104 | 2019-12-02 |
| 1144881509 | Stephanie Barata | Obstetrics & Gynecology | 402 N Keene St Ste 402, Columbia, MO 65201-6986 | 2019-06-26 |
| 1447814181 | Obstetrical Associates of St. Luke's, LLC | Obstetrics & Gynecology | 224 S Woods Mill Rd Ste 750s, Chesterfield, MO 63017-3623 | 2019-04-29 |
| 1508328782 | Lauren Marie Rackovan | Obstetrics & Gynecology | 1011 Bowles Ave Ste 215, Fenton, MO 63026-2387 | 2019-04-04 |
| 1144798737 | Frg Rlt Holdings, Inc. | Obstetrics & Gynecology | 1747 Smizer Station Rd Ste 1, Fenton, MO 63026-2784 | 2018-11-13 |
| 1568984367 | Gsh Lab LLC | Obstetrics & Gynecology | 621 S New Ballas Rd Ste 1017b, Saint Louis, MO 63141-8264 | 2017-07-13 |
| 1851825715 | Sydni Fazenbaker Crowell | Obstetrics & Gynecology | 621 S New Ballas Rd Ste 2009b, Saint Louis, MO 63141 | 2017-04-18 |
| 1063945517 | Donald R Jones Enterprises, LLC | Obstetrics & Gynecology | 225 Physicians Park Ste 300, Poplar Bluff, MO 63901-3930 | 2017-04-11 |
| 1184157984 | Robert Mcdavid | Obstetrics & Gynecology | 3609 Arbor Ct, Columbia, MO 65201-6542 | 2017-04-07 |
| Find all providers with the same taxonomy | ||||
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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.