Provider Demographics
NPI:1407980931
Name:ST. LOUIS GENERAL SURGERY, PC
Entity Type:Organization
Organization Name:ST. LOUIS GENERAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:TERSCHLUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-770-2223
Mailing Address - Street 1:3394 MCKELVEY RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2531
Mailing Address - Country:US
Mailing Address - Phone:314-770-2223
Mailing Address - Fax:314-770-2201
Practice Address - Street 1:3394 MCKELVEY RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2531
Practice Address - Country:US
Practice Address - Phone:314-770-2223
Practice Address - Fax:314-770-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7B83208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202110607Medicaid
MOCS4109OtherRR MEDICARE
MO202110607Medicaid