Provider Demographics
NPI:1619993425
Name:THE AMBULATORY SURGICAL CENTER OF ST. LOUIS, LP
Entity Type:Organization
Organization Name:THE AMBULATORY SURGICAL CENTER OF ST. LOUIS, LP
Other - Org Name:THE SURGICAL CENTER OF ST. LOUIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL, OFFICER-ASST.
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:12184 NATURAL BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2017
Mailing Address - Country:US
Mailing Address - Phone:314-739-0126
Mailing Address - Fax:314-739-0790
Practice Address - Street 1:12184 NATURAL BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2017
Practice Address - Country:US
Practice Address - Phone:314-739-0126
Practice Address - Fax:314-739-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO187-3261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509373700Medicaid
26C0001086Medicare Oscar/Certification
000040076Medicare PIN