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General NPI Number Information
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NPI Number | 1093794927
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Entity Type | Organization
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Legal Business Name | SURGICAL CLINIC INC
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 CHURCH ST
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City | O FALLON
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State | MO
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Zip | 63366-2894
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Country | US
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Telephone | 636-240-1100
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Fax | 636-240-1104
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Provider Business Mailing Address
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Address Line | 103 CHURCH ST
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City | O FALLON
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State | MO
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Zip | 63366-2894
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Country | US
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Telephone | 636-240-1100
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Fax | 636-240-1104
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Authorized Official
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Title or Position | DOCTOR OFFICE MANAGER
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Name | MR. ROBERT J OLIVER
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Credential | DO
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Telephone | 636-240-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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