MEDICARE: NORTH COUNTY GENERAL SURGERY, 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	174400000X	Specialist	33098	MO

General Provider Information

NPI Number	:	1780679415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COUNTY GENERAL SURGERY, INC

Provider Business Mailing Address
First Line	:	11115 NEW HALLS FERRY RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7613
Country	:	US
Telephone Number	:	314-838-5600
Fax Number	:	314-838-5637

Provider Business Practice Location Address
First Line	:	11115 NEW HALLS FERRY RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7613
Country	:	US
Telephone Number	:	314-838-5600
Fax Number	:	314-838-5637

Authorized Official
Title or Position	:	SECRETARY & OFFICE MANAGER
Name	:	MRS. LUZ REYES FLORO
Credential	:	R.N.
Telephone Number	:	314-838-5600

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2020

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