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General NPI Number Information
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NPI Number | 1407251622
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Entity Type | Organization
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Legal Business Name | MASSAC COUNTY SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 1811 E 5TH ST
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City | METROPOLIS
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State | IL
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Zip | 62960
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Country | US
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Telephone | 618-309-6000
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Fax | 618-309-6001
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Provider Business Mailing Address
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Address Line | 600 S CLIFF AVE STE 106
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City | SIOUX FALLS
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State | SD
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Zip | 57104-5355
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Country | US
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Telephone | 605-444-8207
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MELANIE RUSSELL
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Credential | RN
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Telephone | 618-309-6005
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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 |
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License Number State |
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