Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

SSM Regional Health Services

Organization Family Medicine Physician · NPI 1396886065

SSM Regional Health Services provides Family Medicine Physician services in Jefferson City, Missouri. Registered with an NPI since 2007.

In the registry since
2007

Practice location Address checks out

2511 W Edgewood Dr Ste G
Jefferson City, MO 65109-5869
Phone: (573) 761-0458
Fax: (573) 634-3137
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1396886065
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationSSM Regional Health Services
Authorized official Shasta Manuel — Regional Vice President Finance/Cfo · (405) 272-7282
Other names Ssm Health Medical Group - Family Medicine; Ssm Health Medical Group - Family Medicine
NPI enumeratedFebruary 8, 2007
Last updated in NPPESDecember 16, 2025
Certification dateDecember 16, 2025
Mailing address7655 Solutions Ctr, Chicago, IL 60677-7006

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