Provider Demographics
NPI:1578501987
Name:MID-AMERICA SURGICAL GROUP INC
Entity Type:Organization
Organization Name:MID-AMERICA SURGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-771-7677
Mailing Address - Street 1:3535 S JEFFERSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3930
Mailing Address - Country:US
Mailing Address - Phone:314-771-7677
Mailing Address - Fax:314-773-7962
Practice Address - Street 1:3535 S JEFFERSON AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3930
Practice Address - Country:US
Practice Address - Phone:314-771-7677
Practice Address - Fax:314-773-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207721903Medicaid
MO000010614Medicare PIN
MO207721903Medicaid