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Organization
THE ST LOUIS MO ORTHOPAEDIC ASC LLC
Active
Organization
THE ST LOUIS MO ORTHOPAEDIC ASC LLC
Active
Other names
Des Peres Square Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP A CLENDENIN (PRESIDENT)
(615) 665-1283
Entity
Organization
Contact information
Practice address
1050 OLD DES PERES RD, SUITE 150, SAINT LOUIS, MO 63131-1873
(314) 569-2918
(314) 569-9473
Mailing address
1050 OLD DES PERES RD, SUITE 150, SAINT LOUIS, MO 63131-1873
(314) 569-2918
(314) 569-9473
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
171-1
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149879
BLUE CROSS BLUE SHIELD
MO
01
—
490005580
RAILROAD MEDICARE
MO
01
—
611789400
US DEPT OF LABOR
MO
01
—
TRICARE
260042667
MO
Enumeration date
02/21/2006
Last updated
09/07/2023
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