Healthcare Provider Details

I. General information

NPI: 1336373000
Provider Name (Legal Business Name): COMPREHENSIVE SURGICAL AND TESTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR SUITE 382
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

12855 N 40 DR SUITE 382
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-7784
  • Fax: 314-434-4775
Mailing address:
  • Phone: 314-434-7784
  • Fax: 314-434-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2002014802
License Number StateMO

VIII. Authorized Official

Name: DR. ROBERT R. HAGAN
Title or Position: OWNER
Credential: M.D.
Phone: 314-434-7784