MEDICARE: SURGICAL CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1093794927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL CLINIC INC

Provider Business Mailing Address
First Line	:	103 CHURCH ST
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2894
Country	:	US
Telephone Number	:	636-240-1100
Fax Number	:	636-240-1104

Provider Business Practice Location Address
First Line	:	103 CHURCH ST
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2894
Country	:	US
Telephone Number	:	636-240-1100
Fax Number	:	636-240-1104

Authorized Official
Title or Position	:	DOCTOR OFFICE MANAGER
Name	:	MR. ROBERT J OLIVER
Credential	:	DO
Telephone Number	:	636-240-1100

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/22/2020

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Directions to “SURGICAL CLINIC INC ” Practice Location

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