Healthcare Provider Details

I. General information

NPI: 1114934205
Provider Name (Legal Business Name): CENTER FOR SURGICAL SPECIALTIES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 PROSPECT DR
MACON MO
63552-2615
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY ATTN: CREDENTIALING
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-1006
  • Fax: 660-385-1028
Mailing address:
  • Phone: 314-989-0300
  • Fax: 314-810-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number110583
License Number StateMO

VIII. Authorized Official

Name: DONET CHRISTOPHER MAIN
Title or Position: OWNER
Credential: DO
Phone: 660-385-1006