Organization
SSM ST CLARE SURGICAL CENTER LLC
Active
Other names
SSM ST CLARE SURGICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E MCCARVILLE (ADMINISTRATOR)
(417) 889-2040
Entity
Organization
Contact information
Practice address
1055 BOWLES AVE, STE 100, FENTON, MO 63026-2308
(636) 203-9700
(636) 203-9779
Mailing address
1055 BOWLES AVE, STE 100, FENTON, MO 63026-2308
(636) 203-9700
(636) 203-9779
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
229-0
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033351119
—
MO
01
—
P00846977
RAILROAD MEDICARE
MO
Enumeration date
04/03/2009
Last updated
06/04/2020
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