Organization
SOUTH COUNTY SURGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY PARCIAK (OFFICE MANAGER)
(314) 432-2580
Entity
Organization
Contact information
Practice address
10004 KENNERLY RD, SUITE 137A, SAINT LOUIS, MO 63128-2141
(314) 525-4740
(314) 525-4741
Mailing address
PO BOX 1209, MARYLAND HEIGHTS, MO 63043-0209
(314) 432-2580
(314) 432-0223
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R6D37
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
509350609
—
MO
01
—
DG2303
RAILROAD MEDICARE
—
Enumeration date
09/29/2006
Last updated
09/18/2008
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