Provider Demographics
NPI:1689655631
Name:SURGICAL CENTER OF CREVE COEUR
Entity Type:Organization
Organization Name:SURGICAL CENTER OF CREVE COEUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-872-7744
Mailing Address - Street 1:633 EMERSON RD
Mailing Address - Street 2:STE 140
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6739
Mailing Address - Country:US
Mailing Address - Phone:314-872-7744
Mailing Address - Fax:314-810-5296
Practice Address - Street 1:633 EMERSON RD
Practice Address - Street 2:STE 140
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:314-872-7744
Practice Address - Fax:314-810-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO159-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical