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

SSM Regional Health Services

Organization Family Medicine Physician · NPI 1669856829

SSM Regional Health Services provides Family Medicine Physician services in Jefferson City, Missouri. Licensed in Missouri. Registered with an NPI since 2015.

Licensed in
MO
In the registry since
2015
Specialties on file
2
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Practice location Address checks out

2511 W Edgewood Dr Ste F
Jefferson City, MO 65109-5869
Phone: (573) 761-7979
Fax: (573) 761-0445
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X (MO)
Rural Health Clinic/Center Taxonomy 261QR1300X

Record details

NPI number1669856829
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 enumeratedJuly 16, 2015
Last updated in NPPESDecember 16, 2025
Certification dateDecember 16, 2025
Mailing address7655 Solutions Ctr, Chicago, IL 60677-7006

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