Healthcare Provider Details

I. General information

NPI: 1023017837
Provider Name (Legal Business Name): MIDWEST SURGICAL TECHNOLOGIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ MAIL STOP 90-52-343
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

12166 OLD BIG BEND RD SUITE 110
SAINT LOUIS MO
63122-6844
US

V. Phone/Fax

Practice location:
  • Phone: 314-835-1549
  • Fax: 314-835-0069
Mailing address:
  • Phone: 314-835-1549
  • Fax: 314-835-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: KIM R SKRAINKA
Title or Position: EXECUTIVE DIRECTOR
Credential: MHA, MBA
Phone: 314-835-1549