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General NPI Number Information
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NPI Number | 1689667248
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Entity Type | Organization
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Legal Business Name | SUNSET HILLS AMBULATORY SURGERY CENTER LP
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 12399 GRAVOIS RD STE 102
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1750
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Country | US
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Telephone | 314-729-0100
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Fax | 314-729-0168
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Provider Business Mailing Address
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Address Line | 12399 GRAVOIS RD STE 102
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1750
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Country | US
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Telephone | 314-729-0100
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Fax | 314-729-0168
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Authorized Official
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Title or Position | OFFICER, MEDICARE AUTHORIZED OFFICI
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Name | KATHERINE L. REED
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Credential |
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Telephone | 972-763-3859
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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 | 141-1
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 179-9
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License Number State | MO
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