Healthcare Provider Details

I. General information

NPI: 1790393130
Provider Name (Legal Business Name): UNITED SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 CHAMBLEE LN
CREVE COEUR MO
63141-7323
US

IV. Provider business mailing address

638 CHAMBLEE LN
CREVE COEUR MO
63141-7323
US

V. Phone/Fax

Practice location:
  • Phone: 212-920-1382
  • Fax:
Mailing address:
  • Phone: 212-920-1382
  • Fax:

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: SHAWN KUTNIK
Title or Position: OWNER
Credential: MD
Phone: 212-920-1382