NORTHEAST MISSOURI AMBULATORY SURGERY CENTER LLC NPI 1710982699

NPI Information

  • NPI: 1710982699
  • Provider Name: NORTHEAST MISSOURI AMBULATORY SURGERY CENTER LLC
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • CLIA Number: 26D0975386
  • Address: 98 MEDICAL DRIVE
    HANNIBAL, MO
    ZIP 63401
  • Phone: (573) 406-1301

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NPI Details

NORTHEAST MISSOURI AMBULATORY SURGERY CENTER LLC is an ambulatory surgical clinic center in Hannibal, MO. NORTHEAST MISSOURI AMBULATORY SURGERY CENTER LLC NPI is 1710982699. The provider is registered as an organization entity type.

The provider's business location address is:

98 MEDICAL DRIVE
HANNIBAL, MO
ZIP 63401
Phone: (573) 406-1301
Fax: (573) 406-0511

The provider's authorized official is Matthew Johnson .
The authorized official title is Administrator and has the following contact phone number (573) 406-1301.

The CLIA number assigned to this NPI record is 26D0975386 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Removal of polyps or growths of large bowel using an endoscope with mechanical snare (HCPCS:45385)
  • Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS:43239)
  • Biopsy of large bowel using a flexible endoscope (HCPCS:45380)
  • Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk (HCPCS:G0121)
  • Injection of substance into lower spine canal using imaging guidance (HCPCS:62323)
  • Colorectal cancer screening; colonoscopy on individual at high risk (HCPCS:G0105)
  • Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm (HCPCS:43249)
  • Release of wrist ligament using an endoscope (HCPCS:29848)
  • Diagnostic exam of large bowel using a flexible endoscope (HCPCS:45378)
  • Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope (HCPCS:43235)
  • Incision of tendon covering of finger (HCPCS:26055)
  • Repair of shoulder rotator cuff using an endoscope (HCPCS:29827)
  • Removal of knee cartilage using an endoscope (HCPCS:29881)
  • Removal of extensive shoulder joint tissue using an endoscope (HCPCS:29823)
  • Biopsy of prostate gland (HCPCS:55700)

The enumeration date for this NPI number is 6/16/2005 and was last updated on 10/21/2010.

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
1261QA1903XClinic/CenterAmbulatory Surgical108MISSOURIYes

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
1143365OTHERMISSOURIBCBS PROVIDER ID
2=========001MEDICAIDILLINOIS
3505073205MEDICAIDMISSOURI
4431607OTHERMISSOURIHEALTHLINK PROVIDER ID
5490004674OTHERMISSOURIRAILROAD MEDICARE
6000040048MEDICARE ID-TYPE UNSPECIFIEDMISSOURIMEDICARE PROVIDER NUMBER

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: 3/30/2025

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