Provider Demographics
NPI:1003938887
Name:EXECUTIVE CENTRE SURGICAL SERVICES
Entity Type:Organization
Organization Name:EXECUTIVE CENTRE SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-896-0600
Mailing Address - Street 1:145 SAINT PETERS CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5103
Mailing Address - Country:US
Mailing Address - Phone:636-896-0600
Mailing Address - Fax:636-723-2000
Practice Address - Street 1:145 SAINT PETERS CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5103
Practice Address - Country:US
Practice Address - Phone:636-896-0600
Practice Address - Fax:636-723-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty