Basic Information
| Provider Information | |||||||||
| NPI: | 1740245901 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. LOUIS SURGICAL CENTER, LC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. LOUIS SURGICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 OFFICE PKWY | ||||||||
| Address2: | |||||||||
| City: | CREVE COEUR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631417105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149954700 | ||||||||
| FaxNumber: | 3149954701 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 OFFICE PKWY | ||||||||
| Address2: | |||||||||
| City: | CREVE COEUR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631417105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149954700 | ||||||||
| FaxNumber: | 3149954701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 10/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | MORAN | ||||||||
| AuthorizedOfficialFirstName: | JENETHA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9727633893 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 151-1 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.