Healthcare Provider Details

I. General information

NPI: 1780127696
Provider Name (Legal Business Name): MISSOURI COMMONS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 OLIVE BLVD
SAINT LOUIS MO
63141-6313
US

IV. Provider business mailing address

12607 OLIVE BLVD
SAINT LOUIS MO
63141-6313
US

V. Phone/Fax

Practice location:
  • Phone: 143-327-8070
  • Fax: 314-228-1891
Mailing address:
  • Phone: 314-327-8070
  • Fax: 314-228-1891

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: EMILY ELIZABETH LAWLER
Title or Position: MANAGER
Credential:
Phone: 314-378-5422