MEDICARE: NORTH ST LOUIS COUNTY GENERAL SURGERY INC

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	208600000X	Surgery Physician		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19508778	OTHER	MO	MO TAX ID

General Provider Information

NPI Number	:	1306926761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH ST LOUIS COUNTY GENERAL SURGERY INC

Provider Business Mailing Address
First Line	:	11115 NEW HALLS FERRY RD
Second Line	:	SUITE 303
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7613
Country	:	US
Telephone Number	:	314-838-5600
Fax Number	:	314-838-5637

Provider Business Practice Location Address
First Line	:	11115 NEW HALLS FERRY RD
Second Line	:	SUITE 303
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7613
Country	:	US
Telephone Number	:	314-838-5600
Fax Number	:	314-838-5637

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIANO NORIEGA FLORO JR.
Credential	:	M.D.
Telephone Number	:	314-838-5600

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/29/2011

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