Provider Demographics
NPI:1780797910
Name:CRYSTAL CITIES SURGERY CENTER
Entity type:Organization
Organization Name:CRYSTAL CITIES SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-941-0281
Mailing Address - Street 1:21 HAVEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7902
Mailing Address - Country:US
Mailing Address - Phone:314-941-0281
Mailing Address - Fax:314-432-7076
Practice Address - Street 1:1101 WEST GANNON DRIVE
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:314-640-5539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical