Healthcare Provider Details

I. General information

NPI: 1053409896
Provider Name (Legal Business Name): MID COUNTY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8637 DELMAR BLVD
SAINT LOUIS MO
63124-1906
US

IV. Provider business mailing address

PO BOX 790128
SAINT LOUIS MO
63179-0128
US

V. Phone/Fax

Practice location:
  • Phone: 314-983-0303
  • Fax: 314-983-2777
Mailing address:
  • Phone: 314-983-0303
  • Fax: 314-983-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number134-2
License Number StateMO

VIII. Authorized Official

Name: MICHAEL H HORWITZ
Title or Position: CEO
Credential: D.P.M.
Phone: 314-983-0303