Organization
PHYSICIANS SURGERY CENTER AT DEPAUL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAY MANGRICH (GROUP VICE PRESIDENT)
(913) 907-7907
Entity
Organization
Contact information
Practice address
12266 DEPAUL DRIVE, SUITE 10, BRIDGETON, MO 63044
(314) 291-7500
(314) 291-7501
Mailing address
12266 DEPAUL DRIVE, SUITE 10, BRIDGETON, MO 63044
(314) 291-7500
(314) 291-7501
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/12/2006
Last updated
08/22/2020
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