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General NPI Number Information
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NPI Number | 1740364173
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Entity Type | Organization
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Legal Business Name | SPS SURGICAL SERVICES, SC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 6810 STATE ROUTE 162 STE 10
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City | MARYVILLE
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State | IL
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Zip | 62062-8501
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Country | US
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Telephone | 618-288-6100
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Fax | 618-288-6162
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Provider Business Mailing Address
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Address Line | 6810 STATE ROUTE 162 STE 10
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City | MARYVILLE
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State | IL
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Zip | 62062-8501
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Country | US
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Telephone | 618-288-6100
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Fax | 618-288-6162
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Authorized Official
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Title or Position | SURGEON/PRESIDENT
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Name | STEPHEN P STRIEGEL
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Credential | M.D.
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Telephone | 618-288-6100
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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 | 036080224
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License Number State | IL
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