Provider Demographics
NPI:1689667248
Name:SUNSET HILLS AMBULATORY SURGERY CENTER LP
Entity Type:Organization
Organization Name:SUNSET HILLS AMBULATORY SURGERY CENTER LP
Other - Org Name:SUNSET HILLS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER, MEDICARE AUTHORIZED OFFICI
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 1:12399 GRAVOIS RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1750
Mailing Address - Country:US
Mailing Address - Phone:314-729-0100
Mailing Address - Fax:314-729-0168
Practice Address - Street 1:12399 GRAVOIS RD
Practice Address - Street 2:STE 102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1750
Practice Address - Country:US
Practice Address - Phone:314-729-0100
Practice Address - Fax:314-729-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141-1261QA1903X
MO179-9261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00040113Medicare PIN