Healthcare Provider Details

I. General information

NPI: 1255373601
Provider Name (Legal Business Name): CHESTERFIELD AMBULATORY SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17050 BAXTER RD STE 110
CHESTERFIELD MO
63005-1422
US

IV. Provider business mailing address

17050 BAXTER RD STE 110
CHESTERFIELD MO
63005-1422
US

V. Phone/Fax

Practice location:
  • Phone: 636-537-0122
  • Fax: 636-537-0480
Mailing address:
  • Phone: 636-537-0122
  • Fax: 636-537-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number232-5
License Number StateMO

VIII. Authorized Official

Name: CHRISTOPHER HARTSHORN
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 314-800-2017