Provider Demographics
NPI:1578197927
Name:SURGERY CENTERS OF MISSOURI, LLC
Entity Type:Organization
Organization Name:SURGERY CENTERS OF MISSOURI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DK
Authorized Official - Last Name:CRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-695-8933
Mailing Address - Street 1:1015 S SPOEDE RD
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2610
Mailing Address - Country:US
Mailing Address - Phone:314-378-2085
Mailing Address - Fax:314-659-8307
Practice Address - Street 1:12101 WOODCREST EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5047
Practice Address - Country:US
Practice Address - Phone:314-695-8933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3142232162OtherPRIVATE INSURANCE