MEDICARE: APOLLO AMBULATORY 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

General Provider Information

NPI Number	:	1700363611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOLLO AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	10012 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-1826
Country	:	US
Telephone Number	:	314-462-9100
Fax Number	:	800-516-2392

Provider Business Practice Location Address
First Line	:	10012 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-1826
Country	:	US
Telephone Number	:	314-462-9100
Fax Number	:	800-516-2392

Authorized Official
Title or Position	:	OWNER
Name	:	SHAKEEL AHMED
Credential	:	MD
Telephone Number	:	618-239-0678

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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