Provider Demographics
NPI:1710999115
Name:SURGICAL ARTS OF ST LOUIS,LTD
Entity Type:Organization
Organization Name:SURGICAL ARTS OF ST LOUIS,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-770-0991
Mailing Address - Street 1:12266 DEPAUL DR.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2516
Mailing Address - Country:US
Mailing Address - Phone:314-770-0991
Mailing Address - Fax:314-770-0692
Practice Address - Street 1:12266 DEPAUL DR.
Practice Address - Street 2:SUITE 305
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2516
Practice Address - Country:US
Practice Address - Phone:314-770-0192
Practice Address - Fax:314-700-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCD5646OtherRAILROAD MEDICARE
IL200895OtherILLINOIS MEDICARE
IL200894OtherILLINOIS MEDICARE
MOCD5646OtherRAILROAD MEDICARE