Healthcare Provider Details

I. General information

NPI: 1154400471
Provider Name (Legal Business Name): ST. LOUIS WOMEN'S SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 WOODS MILL RD SUITE 100
BALLWIN MO
63011-3657
US

IV. Provider business mailing address

884 WOODS MILL RD STE 100
BALLWIN MO
63011-3657
US

V. Phone/Fax

Practice location:
  • Phone: 636-779-0079
  • Fax: 636-779-0080
Mailing address:
  • Phone: 636-779-0079
  • Fax: 636-779-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number140-2
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5900