Healthcare Provider Details

I. General information

NPI: 1821453796
Provider Name (Legal Business Name): MASON RIDGE AMBULATORY SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17298 NORTH OUTER 40 ROAD SUITE 100
CHESTERFIELD MO
63005
US

IV. Provider business mailing address

17298 NORTH OUTER 40 ROAD SUITE 100
CHESTERFIELD MO
63005
US

V. Phone/Fax

Practice location:
  • Phone: 314-336-1130
  • Fax: 314-336-1136
Mailing address:
  • Phone: 314-336-1130
  • Fax: 314-336-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERICA WEHRMEISTER
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 260-760-9420