Healthcare Provider Details

I. General information

NPI: 1386269314
Provider Name (Legal Business Name): BARIATRIC AND SURGICAL ASSISTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DOUGHERTY FERRY RD STE 430
SAINT LOUIS MO
63122-3325
US

IV. Provider business mailing address

2355 DOUGHERTY FERRY RD STE 430
SAINT LOUIS MO
63122-3325
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-8622
  • Fax: 314-965-8626
Mailing address:
  • Phone: 314-965-8622
  • Fax: 314-965-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW T RICKS
Title or Position: MEMBER
Credential: D.O.
Phone: 314-965-8410