Provider Demographics
NPI:1003110792
Name:CREVE COEUR SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CREVE COEUR SURGERY CENTER, LLC
Other - Org Name:CITY PLACE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:EMMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-997-1777
Mailing Address - Street 1:845 N NEW BALLAS CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7134
Mailing Address - Country:US
Mailing Address - Phone:314-872-7100
Mailing Address - Fax:
Practice Address - Street 1:845 N NEW BALLAS CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7134
Practice Address - Country:US
Practice Address - Phone:314-872-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110-9261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000040049Medicare UPIN