Organization
SURGERY CENTER OF ST. JOSEPH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA J FRY (CLINIC DIRECTOR)
(816) 279-0079
Entity
Organization
Contact information
Practice address
3201 ASHLAND AVE, SAINT JOSEPH, MO 64506-1504
(816) 279-0079
(816) 364-1100
Mailing address
3201 ASHLAND AVE, SAINT JOSEPH, MO 64506-1504
(816) 279-0079
(816) 901-0403
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
119-3
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26C0001012
MEDICARE SUPPLIER
MO
05
—
502343502
—
MO
Enumeration date
07/05/2006
Last updated
04/05/2012
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