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Organization
SSM ST CLARE SURGICAL CENTER LLC
Active
Organization
SSM ST CLARE SURGICAL CENTER LLC
Active
Other names
SSM ST CLARE SURGICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E MCCARVILLE (ADMINISTRATOR)
(417) 889-2040
Entity
Organization
Contact information
Practice address
1055 BOWLES AVE, STE 100, FENTON, MO 63026-2308
(636) 203-9700
(636) 203-9779
Mailing address
1055 BOWLES AVE, STE 100, FENTON, MO 63026-2308
(636) 203-9700
(636) 203-9779
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
229-0
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033351119
—
MO
01
—
P00846977
RAILROAD MEDICARE
MO
Enumeration date
04/03/2009
Last updated
06/04/2020
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