Healthcare Provider Details

I. General information

NPI: 1710041728
Provider Name (Legal Business Name): WEST COUNTY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 EMERSON RD
CREVE COEUR MO
63141-6739
US

IV. Provider business mailing address

633 EMERSON RD
CREVE COEUR MO
63141-6739
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0111
  • Fax: 314-872-9358
Mailing address:
  • Phone: 314-569-0111
  • Fax: 314-872-9358

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: DR. HARRRY CONRAD EGGLESTON
Title or Position: OWNER
Credential: M.D.
Phone: 314-569-0111