Provider Demographics
NPI:1336665470
Name:CENTER FOR SURGICAL EXCELLENCE, LLC
Entity Type:Organization
Organization Name:CENTER FOR SURGICAL EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:O
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-256-0320
Mailing Address - Street 1:1130 TOWN AND COUNTRY COMMONS
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8200
Mailing Address - Country:US
Mailing Address - Phone:636-256-0320
Mailing Address - Fax:636-256-0327
Practice Address - Street 1:1130 TOWN AND COUNTRY COMMONS
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-8200
Practice Address - Country:US
Practice Address - Phone:636-256-0320
Practice Address - Fax:636-256-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical