MEDICARE: MID COUNTY SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	134-2	MO

General Provider Information

NPI Number	:	1053409896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID COUNTY SURGERY CENTER

Provider Business Mailing Address
First Line	:	PO BOX 790128
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63179-0128
Country	:	US
Telephone Number	:	314-983-0303
Fax Number	:	314-983-2777

Provider Business Practice Location Address
First Line	:	8637 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1906
Country	:	US
Telephone Number	:	314-983-0303
Fax Number	:	314-983-2777

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL H HORWITZ
Credential	:	D.P.M.
Telephone Number	:	314-983-0303

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	08/22/2020

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