Provider Demographics
NPI:1447613344
Name:PREMIER SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:PREMIER SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-741-0911
Mailing Address - Street 1:11155 DUNN RD
Mailing Address - Street 2:304E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6150
Mailing Address - Country:US
Mailing Address - Phone:314-741-0911
Mailing Address - Fax:314-741-0501
Practice Address - Street 1:3550 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2527
Practice Address - Country:US
Practice Address - Phone:314-218-9655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LOUIS HEART AND VASCULAR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-30
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical