Healthcare Provider Details

I. General information

NPI: 1265431670
Provider Name (Legal Business Name): AUBURN SURGERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S MOUNT AUBURN RD STE 200
CAPE GIRARDEAU MO
63703-4920
US

IV. Provider business mailing address

PO BOX 70
CAPE GIRARDEAU MO
63702-0070
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-4488
  • Fax: 573-651-4432
Mailing address:
  • Phone: 573-332-7881
  • Fax: 573-651-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number113.2
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY A TOBIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 573-651-4488