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General NPI Number Information
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NPI Number | 1699802330
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Entity Type | Organization
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Legal Business Name | SUBURBAN SURGICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 555 N. NEW BALLAS RD SUITE 265
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6825
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Country | US
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Telephone | 314-991-4644
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Fax | 314-991-4910
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Provider Business Mailing Address
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Address Line | 555 N. NEW BALLAS RD SUITE 265
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6825
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Country | US
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Telephone | 314-991-4644
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Fax | 314-991-4910
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LISA M MOLLOY
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Credential | MBA
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Telephone | 314-991-4644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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