# OLIVE AMBULATORY SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Olive Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588739858
- **Authorized official:** JENETHA D MORAN (OFFICER / AUTHORIZED OFFICIAL)
- **Authorized official phone:** (972) 763-3893

## Contact information

- **Practice address:** 12101 WOODCREST EXECUTIVE DR, STE 101, SAINT LOUIS, MO 63141-5047
- **Practice address phone:** (314) 576-4500
- **Practice address fax:** (314) 576-4503
- **Mailing address:** 12101 WOODCREST EXECUTIVE DR, STE 101, SAINT LOUIS, MO 63141-5047
- **Mailing address phone:** (314) 576-4500
- **Mailing address fax:** (314) 576-4503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 177 | MO | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 01/05/2017