MEDICARE: ADVANCED SURGERY CENTER LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	132-0	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619965324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	12607 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6313
Country	:	US
Telephone Number	:	314-205-1610
Fax Number	:	314-205-1233

Provider Business Practice Location Address
First Line	:	12607 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6313
Country	:	US
Telephone Number	:	314-205-1610
Fax Number	:	314-205-1233

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MELINDA SMITH
Credential	:	R.N.
Telephone Number	:	314-205-1610

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	08/11/2014

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