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General NPI Number Information
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NPI Number | 1720969504
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Entity Type | Organization
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Legal Business Name | MATTIS ROAD SURGERY CENTER LLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 5139 MATTIS RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2250
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Country | US
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Telephone | 314-952-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 5139 MATTIS RD STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2250
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Country | US
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Telephone | 314-952-8001
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN KESSLER
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Credential |
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Telephone | 314-952-8001
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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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