Provider Demographics
NPI:1245566744
Name:CHESTERFIELD ASC, LLC
Entity Type:Organization
Organization Name:CHESTERFIELD ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HRUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-878-3839
Mailing Address - Street 1:1001 CHESTERFIELD PKWY E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2041
Mailing Address - Country:US
Mailing Address - Phone:314-878-3839
Mailing Address - Fax:314-878-6575
Practice Address - Street 1:1001 CHESTERFIELD PKWY E
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2041
Practice Address - Country:US
Practice Address - Phone:314-878-3839
Practice Address - Fax:314-878-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical