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Organization
MASON RIDGE AMBULATORY SURGERY CENTER, LP
Active
Organization
MASON RIDGE AMBULATORY SURGERY CENTER, LP
Active
Other names
Mason Ridge Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE L REED (OFFICER, AUTHORIZED OFFICIAL)
(972) 763-3859
Entity
Organization
Contact information
Practice address
12855 N 40 DR, STE 100, SAINT LOUIS, MO 63141-8657
(314) 878-7150
(314) 878-3051
Mailing address
12855 N 40 DR, STE 100, SAINT LOUIS, MO 63141-8657
(314) 878-7150
(314) 878-3051
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
201-7
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204703
BLUE CROSS BLUE SHIELD
MO
05
—
500092309
—
MO
Enumeration date
02/21/2007
Last updated
08/26/2014
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