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 is a Family Medicine Physician 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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