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General NPI Number Information
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NPI Number | 1477698009
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Entity Type | Organization
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Legal Business Name | MANCHESTER AMBULATORY SURGERY CENTER LP
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 1040 OLD DES PERES RD
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City | DES PERES
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State | MO
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Zip | 63131-1865
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Country | US
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Telephone | 314-775-2264
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Fax | 314-775-2271
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Provider Business Mailing Address
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Address Line | 1040 OLD DES PERES RD
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City | DES PERES
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State | MO
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Zip | 63131-1865
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Country | US
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Telephone | 314-775-2264
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Fax | 314-775-2271
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Authorized Official
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Title or Position | OFFICER OF GENERAL PARTNER COMPANY
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Name | ALEXANDRA O JENKINS
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Credential |
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Telephone | 972-713-3514
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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 | 163-1
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License Number State | MO
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