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General NPI Number Information
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NPI Number | 1154318517
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Entity Type | Organization
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Legal Business Name | CREVE COEUR SURGERY CENTER LLC
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 845 N NEW BALLAS CT SUITE 100
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City | CREVE COEUR
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State | MO
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Zip | 63141-7148
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Country | US
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Telephone | 314-872-7100
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Fax | 314-872-0929
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Provider Business Mailing Address
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Address Line | 845 NORTH NEW BALLAS COURT SUITE 100
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City | CREVE COEUR
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State | MO
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Zip | 63141-7148
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Country | US
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Telephone | 314-872-7100
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Fax | 314-872-0929
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CAROLYN HOLLOWOOD
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Credential | R.N.
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Telephone | 314-872-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 110-4
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License Number State | MO
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