Organization
CHESTERFIELD AMBULATORY SURGERY CENTER LP
Active
Other names
Chesterfield Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER HARTSHORN (OFFICER/AUTHORIZED OFFICIAL)
(314) 800-2017
Entity
Organization
Contact information
Practice address
17050 BAXTER RD, STE 110, CHESTERFIELD, MO 63005-1422
(636) 537-0122
(636) 537-0480
Mailing address
17050 BAXTER RD, STE 110, CHESTERFIELD, MO 63005-1422
(636) 537-0122
(636) 537-0480
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
232-5
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196128
GHP
MO
01
—
26D1023601
CLIA
MO
05
—
509077202
—
MO
01
—
610832100
DEPT. OF LABOR
MO
01
—
P00338546
RAILROAD MEDICARE
MO
Enumeration date
06/11/2006
Last updated
10/04/2024
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