Organization · Type 2 NPI

SSM Regional Health Services

Family Medicine Physician · Jefferson City, MO

NPI number 1396886065 Active

Practice location

2511 W Edgewood Dr Ste G
Jefferson City, MO 65109-5869

Call (573) 761-0458 Map

Fax (573) 634-3137

Mailing address

7655 Solutions Ctr
Chicago, IL 60677-7006

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	None listed

Family Medicine Physician: 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.

3 other providers at this address

Other family medicine physician providers in Jefferson City

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NPI record

NPI: 1396886065
Entity type: Organization (Type 2)
Issued: Feb 8, 2007
Last updated: Dec 16, 2025
Status: Active
Subpart: Yes of SSM Regional Health Services

Other names

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SSM Health Medical Group - Family Medicine · doing business as
SSM Health Medical Group - Family Medicine · doing business as

Authorized official

Shasta Rene Manuel
Regional Vice President Finance/cfo
(405) 272-7282

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1396886065

SSM Regional Health Services's National Provider Identifier is 1396886065, issued on Feb 8, 2007. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Jefferson City, MO. The record was last updated on Dec 16, 2025.