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Organization
DOCTORS PARK SURGERY INC
Active
Organization
DOCTORS PARK SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARIN M ROBERTS (ADMINISTRATOR)
(573) 334-9606
Entity
Organization
Contact information
Practice address
30 DOCTORS PARK, CAPE GIRARDEAU, MO 63703-4928
(573) 334-9606
(573) 334-9608
Mailing address
30 DOCTORS PARK, CAPE GIRARDEAU, MO 63703-4928
(573) 334-9606
(573) 334-9608
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
4616
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1048868
FIRST HEALTH PROVIDER #
MO
01
—
114023
HEALTHLINK PROVIDER ID #
MO
01
—
490001288
RAILROAD MEDICARE
—
05
—
501627400
—
MO
01
—
59
BLUE CROSS BLUE SHIELD ID
MO
Enumeration date
09/12/2005
Last updated
04/16/2009
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