Healthcare Provider Details

I. General information

NPI: 1679113047
Provider Name (Legal Business Name): LIPOSUCTION SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 05/22/2023
Certification Date: 05/19/2023
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: 636-278-1670
Mailing address:
  • Phone: 636-397-4012
  • Fax: 636-278-1670

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