Provider Demographics
NPI:1720732852
Name:NEUROSURGICAL ASSOCIATES OF ST LOUIS LLC
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES OF ST LOUIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-828-8608
Mailing Address - Street 1:3 SAINT ELIZABETH BLVD STE 3900
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1282
Mailing Address - Country:US
Mailing Address - Phone:888-828-8608
Mailing Address - Fax:
Practice Address - Street 1:112 PIPER HILL DR STE 12
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:888-828-8608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty