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General NPI Number Information
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NPI Number | 1598727463
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Entity Type | Organization
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Legal Business Name | CAPE GIRARDEAU OUTPATIENT SURGERY CENTER
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1429 N MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-2171
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Country | US
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Telephone | 573-335-9175
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Fax | 573-334-3390
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Provider Business Mailing Address
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Address Line | 1429 N MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-2171
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Country | US
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Telephone | 573-335-9175
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Fax | 573-334-3390
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Authorized Official
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Title or Position | SURGERY ADMINISTRATOR
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Name | SUZIE VICKERY
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Credential | RN
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Telephone | 573-335-9175
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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 | 53-12
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License Number State | MO
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