Healthcare Provider Details

I. General information

NPI: 1174614523
Provider Name (Legal Business Name): SURGICAL CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD SUITE 253
SAINT LOUIS MO
63141-6835
US

IV. Provider business mailing address

450 N NEW BALLAS RD SUITE 253
SAINT LOUIS MO
63141-6835
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-0776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD L SHARFF JR.
Title or Position: VP/SECRETARY
Credential:
Phone: 205-545-2572