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General NPI Number Information
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NPI Number | 1831160480
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Entity Type | Organization
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Legal Business Name | ST PETERS AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 114 PIPER HILL DR STE 101
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City | SAINT PETERS
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State | MO
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Zip | 63376-1661
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Country | US
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Telephone | 636-928-1670
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Fax | 636-928-3792
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Provider Business Mailing Address
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Address Line | 114 PIPER HILL DR STE 101
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City | SAINT PETERS
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State | MO
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Zip | 63376-1661
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Country | US
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Telephone | 636-928-1670
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Fax | 636-928-3792
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PAUL M SPEZIA
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Credential | D.O.
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Telephone | 636-928-1670
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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 | 100-6
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License Number State | MO
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