Healthcare Provider Details

I. General information

NPI: 1235146325
Provider Name (Legal Business Name): WEBSTER AMBULATORY SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S ELM AVE
WEBSTER GROVES MO
63119-3845
US

IV. Provider business mailing address

520 S ELM AVE
WEBSTER GROVES MO
63119-3845
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-3464
  • Fax: 314-962-0369
Mailing address:
  • Phone: 314-962-3464
  • Fax: 314-962-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number202-2
License Number StateMO

VIII. Authorized Official

Name: KATHERINE L REED
Title or Position: OFFICER, AUTHORIZED OFFICIAL
Credential:
Phone: 972-763-3859