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General NPI Number Information
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NPI Number | 1780797910
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Entity Type | Organization
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Legal Business Name | CRYSTAL CITIES SURGERY CENTER
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 WEST GANNON DRIVE
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City | FESTUS
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State | MO
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Zip | 63028
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Country | US
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Telephone | 314-640-5539
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Fax |
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Provider Business Mailing Address
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Address Line | 21 HAVEN VIEW DR
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7902
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Country | US
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Telephone | 314-941-0281
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Fax | 314-432-7076
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Authorized Official
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Title or Position | COORDINATOR
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Name | MS. SHERYL LYNNE ROSEN
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Credential | RN
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Telephone | 314-941-0281
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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 |
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License Number State |
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