Provider Demographics
NPI:1811162696
Name:SURGEON'S CHOICE LLC
Entity type:Organization
Organization Name:SURGEON'S CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MARIEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:314-458-6717
Mailing Address - Street 1:1144 NEW BALLWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4472
Mailing Address - Country:US
Mailing Address - Phone:314-458-6717
Mailing Address - Fax:636-207-1914
Practice Address - Street 1:1144 NEW BALLWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-4472
Practice Address - Country:US
Practice Address - Phone:314-458-6717
Practice Address - Fax:636-207-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123589163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty