MEDICARE: ADVANCED SURGICAL CARE OF ST. LOUIS, LLC

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

General Provider Information

NPI Number	:	1336649565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SURGICAL CARE OF ST. LOUIS, LLC

Provider Business Mailing Address
First Line	:	232 MAYFAIR PLAZA SHOPPING CTR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-8009
Country	:	US
Telephone Number	:	314-736-4344
Fax Number	:	314-736-4345

Provider Business Practice Location Address
First Line	:	232 MAYFAIR PLAZA SHOPPING CTR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-8009
Country	:	US
Telephone Number	:	314-736-4344
Fax Number	:	314-736-4345

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER HARTSHORN
Credential	:
Telephone Number	:	314-800-2017

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	06/08/2021

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