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Organization
THE SURGERY CENTER OF ST. LOUIS, LLC
Active
Organization
THE SURGERY CENTER OF ST. LOUIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LADEVICH (CEO)
(314) 842-8655
Entity
Organization
Contact information
Practice address
12639 OLD TESSON RD, SUITE 130, SAINT LOUIS, MO 63128-2786
(314) 729-0785
(314) 849-4637
Mailing address
12639 OLD TESSON RD, SUITE 130, SAINT LOUIS, MO 63128-2786
(314) 729-0785
(314) 849-4637
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
129-2
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490005357
RAILROAD MEDICARE
MO
Enumeration date
11/06/2006
Last updated
04/14/2008
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