Healthcare Provider Details

I. General information

NPI: 1578280251
Provider Name (Legal Business Name): CORPORATE SURGICAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MARKET CENTER BLVD STE 203
O FALLON MO
63368-8407
US

IV. Provider business mailing address

1630 MARKET CENTER BLVD STE 203
O FALLON MO
63368-8407
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-4012
  • Fax:
Mailing address:
  • Phone: 636-397-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN MARIE SIMON
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 636-397-4012