Basic Information
| Provider Information | |||||||||
| NPI: | 1891071072 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. CHARLES SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 HARRY S. TRUMAN BLVD. | ||||||||
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| City: | ST. CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63301 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3501 HARRY S. TRUMAN BLVD. | ||||||||
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| City: | ST. CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1111111111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2011 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | CLEVER | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6369466986 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.