MEDICARE: THE AMBULATORY SURGICAL CENTER OF ST. LOUIS, LP

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	187-3	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	:	1619993425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE AMBULATORY SURGICAL CENTER OF ST. LOUIS, LP

Provider Business Mailing Address
First Line	:	12184 NATURAL BRIDGE ROAD
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2017
Country	:	US
Telephone Number	:	314-739-0126
Fax Number	:	314-739-0790

Provider Business Practice Location Address
First Line	:	12184 NATURAL BRIDGE ROAD
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2017
Country	:	US
Telephone Number	:	314-739-0126
Fax Number	:	314-739-0790

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL, OFFICER-ASST.
Name	:	KATHERINE L. REED
Credential	:
Telephone Number	:	972-763-3859

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/18/2009

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