Basic Information
Provider Information
NPI: 1245566744
EntityType: 2
ReplacementNPI:  
OrganizationName: CHESTERFIELD ASC, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 CHESTERFIELD PKWY E
Address2: SUITE 102
City: CHESTERFIELD
State: MO
PostalCode: 630172041
CountryCode: US
TelephoneNumber: 3148783839
FaxNumber: 3148786575
Practice Location
Address1: 1001 CHESTERFIELD PKWY E
Address2: SUITE 102
City: CHESTERFIELD
State: MO
PostalCode: 630172041
CountryCode: US
TelephoneNumber: 3148783839
FaxNumber: 3148786575
Other Information
ProviderEnumerationDate: 10/19/2009
LastUpdateDate: 02/25/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HRUZA
AuthorizedOfficialFirstName: GEORGE
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3148783839
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903X  Y Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

No ID Information.


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