Healthcare Provider Details

I. General information

NPI: 1427273440
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF ST. LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12990 MANCHESTER RD SUITE 1
DES PERES MO
63131-1804
US

IV. Provider business mailing address

200 BREVCO PLZ SUITE 207
LAKE SAINT LOUIS MO
63367-2949
US

V. Phone/Fax

Practice location:
  • Phone: 314-984-0550
  • Fax: 314-984-0501
Mailing address:
  • Phone: 636-561-5450
  • Fax: 636-561-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM ANN LAWSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-561-5450