MEDICARE: RESTORATIVE SURGERY CENTER 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	:	1932719754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	6829 PARKER RD STE B
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-5308
Country	:	US
Telephone Number	:	314-741-2700
Fax Number	:	314-741-2701

Provider Business Practice Location Address
First Line	:	6829 PARKER RD STE B
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-5308
Country	:	US
Telephone Number	:	314-741-2700
Fax Number	:	314-741-2701

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GREGORY A STYNOWICK
Credential	:	MD
Telephone Number	:	314-741-2700

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	06/01/2021

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