ADVANCED SURGERY CENTER LLC NPI 1619965324

NPI Information

NPI: 1619965324
Provider Name: ADVANCED SURGERY CENTER LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 26D1017302

Address:
12607 OLIVE BLVD
SAINT LOUIS, MO
ZIP 63141
Phone: (314) 205-1610
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ADVANCED SURGERY CENTER LLC is an ambulatory surgical clinic center in Saint Louis, MO. ADVANCED SURGERY CENTER LLC NPI is 1619965324. The provider is registered as an organization entity type.

The provider's business location address is:

12607 OLIVE BLVD
SAINT LOUIS, MO
ZIP 63141-313
Phone: (314) 205-1610
Fax: (314) 205-1233

The provider's authorized official is Melinda Smith .
The authorized official title is Administrator and has the following contact phone number (314) 205-1610.

The CLIA number assigned to this NPI record is 26D1017302 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/7/2005 and was last updated on 8/11/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	132-0	MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	506126200	MEDICAID	MISSOURI
2	26C0001074	MEDICARE ID-TYPE UNSPECIFIED	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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