Healthcare Provider Details

I. General information

NPI: 1508828989
Provider Name (Legal Business Name): SOUTH COUNTY OUTPATIENT SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 TESSON FERRY RD
SAINT LOUIS MO
63128-4062
US

IV. Provider business mailing address

13303 TESSON FERRY RD
SAINT LOUIS MO
63128-4062
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KIMBERLY WOOD
Title or Position: DIRECTOR
Credential:
Phone: 828-236-3027