Provider Demographics
NPI:1548224207
Name:JEFFERSON MEMORIAL SURGICAL PARTNERS LLC
Entity Type:Organization
Organization Name:JEFFERSON MEMORIAL SURGICAL PARTNERS LLC
Other - Org Name:JEFFERSON MEMORIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP MANAGED CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:636-549-2384
Mailing Address - Street 1:1377 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4107
Mailing Address - Country:US
Mailing Address - Phone:636-937-4040
Mailing Address - Fax:636-937-4513
Practice Address - Street 1:1377 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4107
Practice Address - Country:US
Practice Address - Phone:636-937-4040
Practice Address - Fax:636-937-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO96-6261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical