Provider Demographics
NPI:1235146325
Name:WEBSTER AMBULATORY SURGERY CENTER LP
Entity Type:Organization
Organization Name:WEBSTER AMBULATORY SURGERY CENTER LP
Other - Org Name:WEBSTER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:520 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3845
Mailing Address - Country:US
Mailing Address - Phone:314-962-3464
Mailing Address - Fax:314-962-0369
Practice Address - Street 1:520 S ELM AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-3845
Practice Address - Country:US
Practice Address - Phone:314-962-3464
Practice Address - Fax:314-962-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO202-2261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000040107Medicare PIN
MO26C0001109Medicare Oscar/Certification