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Organization
PHYSICIAN SURGERY CENTER LLC
Active
Organization
PHYSICIAN SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN S DETERS (PRES)
(217) 342-2255
Entity
Organization
Contact information
Practice address
1500 HIGHWAY 72 EAST, ROLLA, MO 65401
(573) 426-6301
(573) 426-6304
Mailing address
PO BOX 1294, 1207 NETWORK CENTRE BLVD, EFFINGHAM, IL 62401
(217) 342-2255
(217) 342-2619
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168305
BCBS
—
01
—
511377
HEALTHLINK
—
01
—
514184
HEALTHLINK
—
01
—
P00443325
RAILROAD MEDICARE
—
Enumeration date
06/06/2006
Last updated
08/05/2009
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