Provider Demographics
NPI:1932719754
Name:RESTORATIVE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:RESTORATIVE SURGERY CENTER LLC
Other - Org Name:IPS SURGERY CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STYNOWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-741-2700
Mailing Address - Street 1:6829 PARKER RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5308
Mailing Address - Country:US
Mailing Address - Phone:314-741-2700
Mailing Address - Fax:314-741-2701
Practice Address - Street 1:6829 PARKER RD STE B
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5308
Practice Address - Country:US
Practice Address - Phone:314-741-2700
Practice Address - Fax:314-741-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical