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General NPI Number Information
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NPI Number | 1962405803
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Entity Type | Organization
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Legal Business Name | MID RIVERS AMBULATORY SURGERY CENTER LP
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 5401 VETERANS MEMORIAL PKWY STE 100
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City | SAINT PETERS
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State | MO
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Zip | 63376-1680
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Country | US
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Telephone | 636-441-0906
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Fax | 636-928-9288
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Provider Business Mailing Address
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Address Line | 5401 VETERANS MEMORIAL PKWY STE 100
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City | SAINT PETERS
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State | MO
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Zip | 63376-1680
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Country | US
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Telephone | 636-441-0906
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Fax | 636-928-9288
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Authorized Official
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Title or Position | OFFICER/AO
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Name | CHRISTOPHER HARTSHORN
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Credential |
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Telephone | 314-800-2017
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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 | 175
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License Number State | MO
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