Organization
CENTER FOR UROLOGIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES BRADFORD (MANAGING PARTNER)
(214) 738-0357
Entity
Organization
Contact information
Practice address
12855 N 40 DR STE 100, SAINT LOUIS, MO 63141
(314) 594-8230
(314) 594-8246
Mailing address
913 S MAIN ST UNIT 212, GRAPEVINE, TX 76051-7582
(817) 329-4611
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
289-0
MO
Other
Enumeration date
08/07/2017
Last updated
08/30/2022
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