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Organization
MANCHESTER AMBULATORY SURGERY CENTER LP
Active
Organization
MANCHESTER AMBULATORY SURGERY CENTER LP
Active
Other names
Manchester Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRA O JENKINS (OFFICER OF GENERAL PARTNER COMPANY)
(972) 713-3514
Entity
Organization
Contact information
Practice address
1040 OLD DES PERES RD, DES PERES, MO 63131-1865
(314) 775-2264
(314) 775-2271
Mailing address
1040 OLD DES PERES RD, DES PERES, MO 63131-1865
(314) 775-2264
(314) 775-2271
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
163-1
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199232
ANTHEM BC/BS
MO
01
—
242333
GROUP HEALTH PLAN
MO
05
—
507403707
—
MO
01
—
613137600
DOL FECA
MO
01
—
716779
HEALTHLINK
MO
01
—
P00286053
RR MEDICARE
MO
Enumeration date
02/21/2007
Last updated
09/04/2012
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