Provider Demographics
NPI:1255373601
Name:CHESTERFIELD AMBULATORY SURGERY CENTER LP
Entity type:Organization
Organization Name:CHESTERFIELD AMBULATORY SURGERY CENTER LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-800-2017
Mailing Address - Street 1:17050 BAXTER RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1422
Mailing Address - Country:US
Mailing Address - Phone:636-537-0122
Mailing Address - Fax:636-537-0480
Practice Address - Street 1:17050 BAXTER RD
Practice Address - Street 2:STE 110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1422
Practice Address - Country:US
Practice Address - Phone:636-537-0122
Practice Address - Fax:636-537-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO232-5261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26D1023601OtherCLIA
MO509077202Medicaid
MO196128OtherGHP
MO610832100OtherDEPT. OF LABOR
MOP00338546OtherRAILROAD MEDICARE
26C0001082Medicare Oscar/Certification
MO000049082Medicare PIN