Provider Demographics
NPI:1013599760
Name:ST. LOUIS SURGICAL GROUP, LLC
Entity Type:Organization
Organization Name:ST. LOUIS SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-735-3577
Mailing Address - Street 1:253 CHESTERFIELD INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1201
Mailing Address - Country:US
Mailing Address - Phone:636-735-3577
Mailing Address - Fax:
Practice Address - Street 1:253 CHESTERFIELD INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1201
Practice Address - Country:US
Practice Address - Phone:636-735-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477617025OtherNPI