Provider Demographics
NPI:1033180658
Name:SURGERY CENTER OF FARMINGTON, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF FARMINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WIGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-756-8000
Mailing Address - Street 1:400 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2906
Mailing Address - Country:US
Mailing Address - Phone:573-756-8000
Mailing Address - Fax:573-756-8288
Practice Address - Street 1:400 PARKLAND DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2906
Practice Address - Country:US
Practice Address - Phone:573-756-8000
Practice Address - Fax:573-756-8288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGERY CENTER OF FARMINGTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-31
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326103490OtherNPI
MO1942312061OtherNPI
MO1437104304OtherNPI
MO504759218Medicaid
MO1437104304OtherNPI
MO1326103490OtherNPI
MO504759218Medicaid
MOA12841Medicare UPIN